Active NPI
Katie Y. Kim
- Dentist
- San Bernardino, CA
National Provider Identifier
1336288893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 54464
- Practice address
- 1199 N E St
San Bernardino, CA 92410-3507 - Phone
- (909) 381-6507
- Fax
- (909) 381-9517
- NPI assigned
- Feb 5, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 54464 | CA | Primary |
Addresses
Primary practice location
1199 N E St
San Bernardino, CA 92410-3507
Mailing address
2116 Owens Dr.
Fullerton, CA 92833
Phone (909) 381-6507
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D54464 | Medicaid | CA |
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 |
|---|---|---|---|
| 54464 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Western Dental Services, Inc. | Past | Accepting new patients |
Interoperability endpoints
- kkim@direct.westerndental.com
- katie.kim.p1@direct.careclinic.nextgenshare.com
Organizations & group practices 1
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.
-
- General Practice Dentistry
- San Bernardino, CA
- NPI 1457413973
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1336288893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2116 OWENS DR.",
"city": "FULLERTON",
"state": "CA",
"postal_code": "92833",
"telephone_number": "909-381-6507",
"fax_number": "714-571-3560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1199 N E ST",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924103507",
"telephone_number": "909-381-6507",
"fax_number": "909-381-9517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "KATIE",
"middle_name": "Y.",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-05",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "54464",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "D54464",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.