Active NPI
Sarah Soonyoung Kim, D.D.S.
- Dentist
- Riverside, CA
National Provider Identifier
1407048192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 56036
- Practice address
- 5225 Canyon Crest Dr Ste 309
Riverside, CA 92507-6324 - Phone
- (909) 380-2544
- NPI assigned
- Aug 15, 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 56036 | CA | Primary |
Addresses
Primary practice location
5225 Canyon Crest Dr Ste 309
Riverside, CA 92507-6324
Mailing address
11467 Via Capri
Loma Linda, CA 92354-3853
Phone (310) 614-3593
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170109002135 | CA | Order and Referring Only - Other (Physician) | 0648551549 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405382400000",
"number": "1407048192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11467 VIA CAPRI",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923543853",
"telephone_number": "310-614-3593"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5225 CANYON CREST DR STE 309",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925076324",
"telephone_number": "909-380-2544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SARAH",
"middle_name": "SOONYOUNG",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-08-15",
"last_updated": "2014-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "56036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2014; 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.