Keun Won Kim, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

109188 Issued in CA

Practice address

1200 Rosecrans Ave Ste 210
Manhattan Beach, CA 90266-2470

Phone

(310) 414-0620

NPI assigned

Sep 5, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Comprehensive Community Health Centers Inc

  • Family Medicine Physician
  • Glendale, CA
  • NPI 1356362743
  Medicare reassignment NPD
• Comprehensive Community Health Centers, Inc

  • Family Medicine Physician
  • Arleta, CA
  • NPI 1346951654
  NPD
• Sea Breeze Dental Group

  • Dental Clinic/Center
  • Manhattan Beach, CA
  • NPI 1790665008
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1693872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693872000000",
    "number": "1376329391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "848 GRAMERCY DR APT 103",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900053417",
            "telephone_number": "310-570-0053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 ROSECRANS AVE STE 210",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902662470",
            "telephone_number": "310-414-0620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "KEUN WON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-05",
        "last_updated": "2023-09-05",
        "certification_date": "2023-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "109188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melanie Pattraphone Khamlong, MD
• Heba E Khorshid
• Diane Kim, L.AC.
• Eunice You Kyung Kim, M.S., BCBA
• Helen Jinsun Kim, MD
• Mi Hyun Kim, PHARMD
• Sarah Yoon Kim, PHARMD
• Christina King
• Lee Kissel, MD
• Nima Kohanpour, PHARMD

• General Practice Dentistry in Manhattan Beach, CA
• Providers in Manhattan Beach, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2023; 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.

Verify at the official NPI Registry.