Active NPI
Gitae Kim, D.D.S.
- General Practice Dentistry
- Los Angeles, CA
National Provider Identifier
1407180342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 58750
- Practice address
- 3054 W 8TH St
#106
Los Angeles, CA 90005-1898 - Phone
- (213) 384-2864
- Fax
- (213) 384-2386
- NPI assigned
- Sep 24, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 58750 | CA | |
| General Practice Dentistry | 1223G0001X | 58750 | CA | Primary |
Addresses
Primary practice location
3054 W 8TH St
#106
Los Angeles, CA 90005-1898
Mailing address
20416 Fuero Dr
Walnut, CA 91789-2439
Phone (213) 505-6449
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58750 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marie Kim DDS., Inc | Dentist | Past | Accepting new patients |
| Gitae Kim Dental Group Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Dental Clinic/Center
- Los Angeles, CA
- NPI 1962919571
-
- Dentist
- Los Angeles, CA
- NPI 1952262636
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253750400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1567641600000",
"number": "1407180342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20416 FUERO DR",
"city": "WALNUT",
"state": "CA",
"postal_code": "917892439",
"telephone_number": "213-505-6449",
"fax_number": "213-384-2386"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3054 W 8TH ST",
"address_2": "#106",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900051898",
"telephone_number": "213-384-2864",
"fax_number": "213-384-2386"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "GITAE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-09-24",
"last_updated": "2019-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "58750",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "58750",
"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 Sep 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.