Active NPI
Taera Kim, DMD
- Orthodontics and Dentofacial Orthopedics Dentistry
- Los Angeles, CA
National Provider Identifier
1366625816
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 56631
- Practice address
- 680 Wilshire PL
Suite 411
Los Angeles, CA 90005-3931 - Phone
- (213) 738-7077
- NPI assigned
- Dec 6, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 56631 | CA | Primary |
Addresses
Primary practice location
680 Wilshire PL
Suite 411
Los Angeles, CA 90005-3931
Mailing address
5057 Fulton Ave
Sherman Oaks, CA 91423-1501
Phone (213) 400-4938
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 28, 2020 through Oct 28, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1267747200000",
"number": "1366625816",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5057 FULTON AVE",
"city": "SHERMAN OAKS",
"state": "CA",
"postal_code": "914231501",
"telephone_number": "213-400-4938"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "680 WILSHIRE PL",
"address_2": "SUITE 411",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900053931",
"telephone_number": "213-738-7077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "TAERA",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-12-06",
"last_updated": "2010-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "CA",
"license": "56631",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.