Active NPI
Ja Young Kim
- Dentist
- New York, NY
National Provider Identifier
1417634510
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DDS110670
- Practice address
- 345 E 24TH St
New York, NY 10010-4020 - Phone
- (212) 998-9880
- NPI assigned
- Jun 29, 2023
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | DDS110670 | CA | Primary |
Addresses
Primary practice location
345 E 24TH St
New York, NY 10010-4020
Mailing address
13362 Woodland Dr
Tustin, CA 92780-4762
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 |
|---|---|---|---|---|
| I20250812000175 | CA | Order and Referring Only - Dentist | 9537667357 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS110670 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728000000000",
"number": "1417634510",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13362 WOODLAND DR",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927804762"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "345 E 24TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100104020",
"telephone_number": "212-998-9880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JA YOUNG",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-29",
"last_updated": "2024-10-04",
"certification_date": "2024-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "DDS110670",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; 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.