Jae Eun Kim, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

104068 Issued in CA

Practice address

8819 Whittier Blvd Ste 102
Pico Rivera, CA 90660-2673

Phone

(562) 699-1000

Fax

(562) 699-1099

NPI assigned

Jul 19, 2019

Last updated

Apr 13, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Jae Eun Kim, DMD Dentistry Inc

  • Dental Clinic/Center
  • Pico Rivera, CA
  • NPI 1043927015
  NPD Authorized official
• JK Family Dental Inc

  dba Dental Practice of Jae Eun Kim, DMD

  • Dental Clinic/Center
  • Pico Rivera, CA
  • NPI 1104570548
  NPD Authorized official

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

{
    "created_epoch": "1563494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681344000000",
    "number": "1285287110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8819 WHITTIER BLVD STE 102",
            "city": "PICO RIVERA",
            "state": "CA",
            "postal_code": "906602673",
            "telephone_number": "562-699-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8819 WHITTIER BLVD STE 102",
            "city": "PICO RIVERA",
            "state": "CA",
            "postal_code": "906602673",
            "telephone_number": "562-699-1000",
            "fax_number": "562-699-1099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14880 Whittier Blvd",
            "address_purpose": "LOCATION",
            "city": "Whittier",
            "state": "CA",
            "postal_code": "906051727",
            "country_code": "US",
            "telephone_number": "562-567-9051",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "JAE EUN",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-19",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "CA",
            "license": "104068",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "104068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVAILITY",
            "identifier": "104068",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104068",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David J Kelly, M.D.
• Khalid B Ahmed MD Apc
• Khalid B. Ahmed M.D. Inc.
• Jean Annette Killebrew, M.A. M.F.T.
• In Il Kim, PHARM.D.
• Michele L. Kim, DDS
• Gemma Tok Hyon Ko, M.D.
• Nancy M Ko, RPH
• Joanna Kong, RPA-C
• La Cliniquita, Inc.

• General Practice Dentistry in Pico Rivera, CA
• Providers in Pico Rivera, 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 Apr 13, 2023; 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.