Maria Antonette De Lara Kim, RDH, RDHAP

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

783 Issued in CA

Practice address

66 S San Gorgonio Ave Ste 5
Banning, CA 92220-6020

Phone

(951) 553-8235

NPI assigned

Nov 7, 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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Trusmile Dental Hygiene Practice of Kim, Inc.

  • Dental Hygienist
  • Banning, CA
  • NPI 1467055566
  NPD Authorized official

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

{
    "created_epoch": "1604707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614816000000",
    "number": "1417558180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 S SAN GORGONIO AVE STE 5",
            "city": "BANNING",
            "state": "CA",
            "postal_code": "922206020",
            "telephone_number": "951-922-4975",
            "fax_number": "951-922-4976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 S SAN GORGONIO AVE STE 5",
            "city": "BANNING",
            "state": "CA",
            "postal_code": "922206020",
            "telephone_number": "951-553-8235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MARIA ANTONETTE",
        "middle_name": "DE LARA",
        "credential": "RDH, RDHAP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-07",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "CA",
            "license": "783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Kean
• Alicia M Keller Taton
• Lewis E. Kemmerer, OD
• Afua I Khumalo, RD
• Jinsoo Jason Kim, PH.D.
• Nickolas Alexander King
• Daniel Chesley Kirk, PT
• Alishia Nicole Koshmerl
• Stephanie La Ferriere
• Carri Ranie Lakes, NP

• Dental Hygienist in Banning, CA
• Providers in Banning, CA by specialty
• Dental Hygienist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2021; 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.