Active NPI
Justin Im
- Pediatric Dentistry
- Apple Valley, CA
National Provider Identifier
1316520364
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 106857
- Practice address
- 18564 US Highway 18 Ste 301
Apple Valley, CA 92307-2340 - Phone
- (079) 076-0490
- NPI assigned
- Apr 28, 2021
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 106857 | CA | Primary |
Addresses
Primary practice location
18564 US Highway 18 Ste 301
Apple Valley, CA 92307-2340
Mailing address
Third Ave. and 183Rd Street
Bronx, NY 10457
Other practice location 1
Third Ave. and 183rd Street
Bronx, NY 10457
Phone (718) 618-8961
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 |
|---|---|---|---|
| 106857 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712188800000",
"number": "1316520364",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "THIRD AVE. AND 183RD STREET",
"city": "BRONX",
"state": "NY",
"postal_code": "10457"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18564 US HIGHWAY 18 STE 301",
"city": "APPLE VALLEY",
"state": "CA",
"postal_code": "923072340",
"telephone_number": "079-076-0490"
}
],
"practiceLocations": [
{
"address_1": "Third Ave. and 183rd Street",
"address_purpose": "LOCATION",
"city": "Bronx",
"state": "NY",
"postal_code": "10457",
"country_code": "US",
"telephone_number": "718-618-8961",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "IM",
"first_name": "JUSTIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-04-28",
"last_updated": "2024-04-04",
"certification_date": "2024-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "106857",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Apple Valley, CA
- Nazifa Ibnath, MD
- Erica Lauren Ike, D.O
- Mostafa S. Ilbeigi, M.D.
- Parastou Ilbeigi, D.C.
- Pedram Ilbeigi, D.O.
- Industrial Medical Services & Team Therapy, Inc.
- Infinity Medical Group, Inc.
- Keishon Ross Ingram
- Inland Cardiothoracic Surgical Associates Medical Group
- Inland Cardiothoracic Surgical Associates Medical Group Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 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.