NPIMap

Organization Active NPI

Skim DDS Inc

Doing business as Premier Dental Suite

  • Dentist
  • Palmdale, CA
National Provider Identifier
1386192821
Registry record updated Nov 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
58863 Issued in CA
Legal business name
SKIM DDS INC
Doing business as
Premier Dental Suite
Practice address
4635 E Avenue S
# C103
Palmdale, CA 93552-4483
Phone
(661) 349-8280
Fax
(661) 349-4462
NPI assigned
Sep 13, 2016
Last updated
Nov 21, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2017

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

Authorized official

Name
Dr. Song K Kim, DDSNPI 1700115342
Title
President
Phone
(661) 349-8280

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 58863 CA Primary

Addresses

Primary practice location

4635 E Avenue S
# C103
Palmdale, CA 93552-4483

Mailing address

4635 E Avenue S
# C103
Palmdale, CA 93552-4483
Phone (661) 349-8280

Other names 1

  • Premier Dental Suite Doing business as

National Provider Directory

National Provider Directory

Locations

4635 E Avenue S
#C103
Palmdale, CA 93552
Phone (661) 349-8280

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1473724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511222400000",
    "number": "1386192821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4635 E AVENUE S",
            "address_2": "# C103",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "935524483",
            "telephone_number": "661-349-8280",
            "fax_number": "661-349-4462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4635 E AVENUE S",
            "address_2": "# C103",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "935524483",
            "telephone_number": "661-349-8280",
            "fax_number": "661-349-4462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKIM DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-13",
        "last_updated": "2017-11-21",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "SONG",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "661-349-8280",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "58863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Dental Suite",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palmdale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 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.

Verify at the official NPI Registry.