Audrey Borahm Kim, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

105474 Issued in CA

Practice address

1St Dental Battalion/Naval Dental Center
Attn: Medical Staff Sves; BLDG 2238 a Ave
Camp Pendleton, CA 92055-5221

Phone

(818) 939-1914

NPI assigned

Sep 16, 2020

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1600214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600214400000",
    "number": "1386250355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56869 ANTELOPE TRL APT 6",
            "city": "YUCCA VALLEY",
            "state": "CA",
            "postal_code": "922842871",
            "telephone_number": "818-939-1914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1ST DENTAL BATTALION/NAVAL DENTAL CENTER",
            "address_2": "ATTN: MEDICAL STAFF SVES; BLDG 2238 A AVE",
            "city": "CAMP PENDLETON",
            "state": "CA",
            "postal_code": "920555221",
            "telephone_number": "818-939-1914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "AUDREY",
        "middle_name": "BORAHM",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-16",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "105474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alanna Kennedy, PA
• Zaman Khan
• Khin Kay Khine, DO
• Ruslei Marie Khoury, FNP
• Cassandra Elise Kijek, MD
• Cecilia Kim, DO
• Daniel E Kim
• Shin Joseph Kim, D.D.S.
• Thomas Kiner, M.D.
• William King-Lewis, M.D.

• General Practice Dentistry in Camp Pendleton, CA
• Providers in Camp Pendleton, 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 16, 2020; 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.