Individual provider Active NPI

Kim Thuc Trinh, DDS

  • Pediatric Dentistry
  • Fullerton, CA
National Provider Identifier
1174904783
Registry record updated Oct 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
100082 Issued in CA
Practice address
1950 Sunny Crest Dr Ste 3300
Fullerton, CA 92835-3641
Phone
(714) 870-6120
NPI assigned
Jun 10, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 100082 CA Primary

Addresses

Primary practice location

1950 Sunny Crest Dr Ste 3300
Fullerton, CA 92835-3641

Mailing address

1301 S Jefferson Ave
Fullerton, CA 92832-3119

Other practice location 1

2239 N School St
Honolulu, HI 96819-2539
Phone (808) 791-9400

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20210219002318 CA Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 8022423276

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
James Park DDS, Inc. Pediatric Dentistry CurrentSince Dec 16, 2020 Accepting new patients

Locations

1950 Sunny Crest Dr
Ste 3300
Fullerton, CA 92835
Phone (310) 497-2570

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1433894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1174904783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 S JEFFERSON AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928323119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 SUNNY CREST DR STE 3300",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353641",
            "telephone_number": "714-870-6120"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2239 N School St",
            "address_purpose": "LOCATION",
            "city": "Honolulu",
            "state": "HI",
            "postal_code": "968192539",
            "country_code": "US",
            "telephone_number": "808-791-9400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TRINH",
        "first_name": "KIM",
        "middle_name": "THUC",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-10",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "100082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

Verify at the official NPI Registry.