NPIMap

Organization Active NPI

Kyung Myun Kim DDS Corporation

  • General Practice Dentistry
  • Laguna Hills, CA
National Provider Identifier
1194103093
Registry record updated Jul 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
11815 Issued in CA
Legal business name
KYUNG MYUN KIM DDS CORPORATION
Practice address
24953 Paseo de Valencia Ste 13C
Laguna Hills, CA 92653-4344
Phone
(949) 770-4275
Fax
(949) 770-0538
NPI assigned
May 12, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2015

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

Authorized official

Name
Yang Kim
Title
Administrator
Phone
(714) 505-2010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 11815 CA Primary

Addresses

Primary practice location

24953 Paseo de Valencia Ste 13C
Laguna Hills, CA 92653-4344

Mailing address

24953 Paseo de Valencia Ste 13C
Laguna Hills, CA 92653-4344
Phone (949) 770-4275

Other identifiers 1

IdentifierTypeStateIssuer
G93667-01MedicaidCA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1431388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437004800000",
    "number": "1194103093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24953 PASEO DE VALENCIA STE 13C",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926534344",
            "telephone_number": "949-770-4275",
            "fax_number": "949-770-0538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24953 PASEO DE VALENCIA STE 13C",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926534344",
            "telephone_number": "949-770-4275",
            "fax_number": "949-770-0538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KYUNG MYUN KIM DDS CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-12",
        "last_updated": "2015-07-16",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "YANG",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "714-505-2010"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "11815",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G93667-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laguna Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.