Active NPI
Brian Songsu Kim, D.M.D.
- General Practice Dentistry
- Delano, CA
National Provider Identifier
1295868636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4095501
- Practice address
- 1406 Jefferson St
Delano, CA 93215-2222 - Phone
- (661) 725-9430
- Fax
- (661) 725-7221
- NPI assigned
- Mar 14, 2007
- Sex
- Male
- 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 | 4095501 | CA | Primary |
Addresses
Primary practice location
1406 Jefferson St
Delano, CA 93215-2222
Mailing address
1406 Jefferson St
Delano, CA 93215-2222
Phone (661) 725-9430
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B4095501 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160304000938 | CA | Practitioner - Oral Surgery | 8123324977 | Practice locations: Delano, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4095501 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brian Songsu Kim | General Practice | Past | Accepting new patients |
| Brian Songsu Kim | General Practice | Past | Accepting new patients |
| Brian Songsu Kim | General Practice | Past | Accepting new patients |
| Dr D S Park Dental Inc | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Delano, CA
- NPI 1477196244
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1295868636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1406 JEFFERSON ST",
"city": "DELANO",
"state": "CA",
"postal_code": "932152222",
"telephone_number": "661-725-9430",
"fax_number": "661-725-7221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1406 JEFFERSON ST",
"city": "DELANO",
"state": "CA",
"postal_code": "932152222",
"telephone_number": "661-725-9430",
"fax_number": "661-725-7221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "BRIAN",
"middle_name": "SONGSU",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-14",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "4095501",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "B4095501",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Delano, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.