Active NPI
Kenny Kim, DDS
- Dentist
- Lakewood, CA
National Provider Identifier
1336352830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 54955
- Practice address
- 20147 Pioneer Blvd
Lakewood, CA 90715-1051 - Phone
- (562) 924-0558
- NPI assigned
- May 8, 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 | 54955 | CA | Primary |
Addresses
Primary practice location
20147 Pioneer Blvd
Lakewood, CA 90715-1051
Mailing address
20147 Pioneer Blvd
Lakewood, CA 90715-1051
Phone (562) 924-0558
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kenny Young Kim DDS Inc | Dentist | Past | Accepting new patients |
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.
-
- Dentist
- Lakewood, CA
- NPI 1033664172
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513209600000",
"number": "1336352830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20147 PIONEER BLVD",
"city": "LAKEWOOD",
"state": "CA",
"postal_code": "907151051",
"telephone_number": "562-924-0558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20147 PIONEER BLVD",
"city": "LAKEWOOD",
"state": "CA",
"postal_code": "907151051",
"telephone_number": "562-924-0558"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "KENNY",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-08",
"last_updated": "2017-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "54955",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.