Active NPI
Eunice Gowoon Kim, DDS
- General Practice Dentistry
- Los Angeles, CA
National Provider Identifier
1275019143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 102783
- Practice address
- 2805 S San Pedro St
Los Angeles, CA 90011-2023 - Phone
- (708) 949-0395
- NPI assigned
- Jul 13, 2018
- Last updated
- Aug 22, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 102783 | CA | Primary |
Addresses
Primary practice location
2805 S San Pedro St
Los Angeles, CA 90011-2023
Mailing address
2525 Wilshire Blvd Apt 713
Los Angeles, CA 90057-3563
Phone (213) 505-2075
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102783 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eunice G Kim DDS Inc | General Practice | Current | Accepting new patients |
| Lee & Kim Dental Group, Inc. | General Practice | Current | Accepting new patients |
Organizations & group practices 2
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.
-
- General Practice Dentistry
- La Puente, CA
- NPI 1073231346
-
- General Practice Dentistry
- Bell Gardens, CA
- NPI 1538019310
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661126400000",
"number": "1275019143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2525 WILSHIRE BLVD APT 713",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900573563",
"telephone_number": "213-505-2075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2805 S SAN PEDRO ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900112023",
"telephone_number": "708-949-0395"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "EUNICE",
"middle_name": "GOWOON",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-07-13",
"last_updated": "2022-08-22",
"certification_date": "2022-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "102783",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.