Nathan Daebhum Kim, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DDS109885 Issued in CA

Practice address

179 N Tustin St
Orange, CA 92867-7716

Phone

(714) 288-1035

NPI assigned

Nov 9, 2021

Last updated

Jul 2, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Pakravan Dental Corporation

  dba West Coast Dental Group of Orange

  • General Practice Dentistry
  • Orange, CA
  • NPI 1073737524
  NPD (past)

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

{
    "created_epoch": "1636416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719878400000",
    "number": "1245996784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5603 OROUKE RD",
            "city": "SUGAR HILL",
            "state": "GA",
            "postal_code": "305182153",
            "telephone_number": "678-702-3050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "179 N TUSTIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928677716",
            "telephone_number": "714-288-1035"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Woodhull Medical Center 760 Broadway",
            "address_2": "Room 2c319",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "11206",
            "country_code": "US",
            "telephone_number": "718-963-8310",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "250 E International Speedway Blvd",
            "address_purpose": "LOCATION",
            "city": "Deland",
            "state": "FL",
            "postal_code": "327242340",
            "country_code": "US",
            "telephone_number": "386-626-3296",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9050 Whittier Blvd",
            "address_purpose": "LOCATION",
            "city": "Pico Rivera",
            "state": "CA",
            "postal_code": "906602410",
            "country_code": "US",
            "telephone_number": "562-456-1111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "NATHAN",
        "middle_name": "DAEBHUM",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-09",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "DDS109885",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "26956",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Eunjee Kim, D.O.
• Michelle Myunghee Kim, MD
• Min Hee Kim
• Miyeon Kim
• Moon Hyun Kim, M.D,
• Patricia Kim
• Paul Kim
• Paul Sungyul Kim, MD
• Peter H. Kim, M.D.
• Reina Nae Kim, NP

• Dentist in Orange, CA
• Providers in Orange, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2024; 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.