Susan J. Kim, D.D.S., Inc

Primary specialty

DentistTaxonomy code 122300000X

License

48731 Issued in CA

Legal business name

SUSAN J. KIM, D.D.S., INC

Doing business as

Lakeview Family Dental

Practice address

11998 Foothill Boulevard
Lake View Terrace, CA 91342

Phone

(818) 897-5055

Fax

(818) 897-0218

NPI assigned

Jun 5, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Susan Ji Hyun Kim, D.D.S.

Title

Owner

Phone

(818) 897-5055

Specialties & licenses 1

Addresses

Other names 1

• Lakeview Family Dental Doing business as

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

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285836635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11998 FOOTHILL BOULEVARD",
            "city": "LAKE VIEW TERRACE",
            "state": "CA",
            "postal_code": "91342",
            "telephone_number": "818-897-5055",
            "fax_number": "818-897-0218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11998 FOOTHILL BOULEVARD",
            "city": "LAKE VIEW TERRACE",
            "state": "CA",
            "postal_code": "91342",
            "telephone_number": "818-897-5055",
            "fax_number": "818-897-0218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN J. KIM, D.D.S., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "JI HYUN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-897-5055",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "48731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeview Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jocelyn Yanet Soto Gutierrez
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• Brooke Ashley Stanfield
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• Olga Sykes, CCJP
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• Michael Andrew Trujillo, CADCII

• Dentist in Lake View Terrace, CA
• Providers in Lake View Terrace, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.