Anne S. Kim DDS, Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

55536 Issued in CA

Legal business name

ANNE S. KIM DDS, INC.

Practice address

19333 Bear Valley Rd Ste 205
Apple Valley, CA 92308-5150

Phone

(760) 247-4155

Fax

(760) 247-4955

NPI assigned

Sep 19, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Anne Sooyun Kim, DDS

Title

Ceo

Phone

(760) 247-4155

Specialties & licenses 1

Addresses

Other names 1

• Infinity Dental Spa Doing business as

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

{
    "created_epoch": "1474243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474243200000",
    "number": "1194273102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19333 BEAR VALLEY RD STE 205",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923085150",
            "telephone_number": "760-247-4155",
            "fax_number": "760-247-4955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19333 BEAR VALLEY RD STE 205",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923085150",
            "telephone_number": "760-247-4155",
            "fax_number": "760-247-4955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANNE S. KIM DDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-19",
        "last_updated": "2016-09-19",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "ANNE",
        "authorized_official_middle_name": "SOOYUN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "760-247-4155",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "55536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Infinity Dental Spa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Apple Valley, CA
• Providers in Apple Valley, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2016; 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.