Donghwan Kim, DDS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

103804 Issued in CA

Practice address

1570 7TH St
Sanger, CA 93657-2402

Phone

(800) 492-4227

NPI assigned

Jun 18, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: donghwan.kim.p1@direct.altura.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fresno Community Hospital and Medical Center

  • General Acute Care Hospital
  • Fresno, CA
  • NPI 1104906569
  NPD (past)
• United Health Centers of the San Joaquin Valley

  • Federally Qualified Health Center (FQHC)
  • Huron, CA
  • NPI 1134101686
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788220800000",
    "number": "1164082483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2940 W TYLER AVE",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932916567",
            "telephone_number": "559-331-9502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1570 7TH ST",
            "city": "SANGER",
            "state": "CA",
            "postal_code": "936572402",
            "telephone_number": "800-492-4227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "DONGHWAN",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-18",
        "last_updated": "2026-09-01",
        "certification_date": "2026-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "103804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brianna Kebo, OD
• Larry Kebo, O.D.
• Katie Kennedy
• Kim Tran DDS, Inc.
• Brandon Kim
• Stephanie Michelle King, M.S., R.D.
• Kings View
• Larry Kebo, OD, Inc
• Linda Lee, DDS
• Nou Lee, PHARMD

• Orthodontics and Dentofacial Orthopedics Dentistry in Sanger, CA
• Providers in Sanger, CA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.