Active NPI
Daul Kim
- Dentist
- Reno, NV
National Provider Identifier
1417787524
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 8085
- Practice address
- 59 Damonte Ranch Pkwy Ste F
Reno, NV 89521-2989 - Phone
- (775) 851-2204
- NPI assigned
- Aug 5, 2024
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8085 | NV | Primary |
Addresses
Primary practice location
59 Damonte Ranch Pkwy Ste F
Reno, NV 89521-2989
Mailing address
2060 Experience Ave Unit 537
Reno, NV 89502-1397
Phone (909) 809-6320
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 |
|---|---|---|---|
| 8085 | NV | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Callaway-Nelson Reno Modern Dentistry, PC | Dentist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dentist
- Reno, NV
- NPI 1285978981
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1722816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722816000000",
"number": "1417787524",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2060 EXPERIENCE AVE UNIT 537",
"city": "RENO",
"state": "NV",
"postal_code": "895021397",
"telephone_number": "909-809-6320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "59 DAMONTE RANCH PKWY STE F",
"city": "RENO",
"state": "NV",
"postal_code": "895212989",
"telephone_number": "775-851-2204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "DAUL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-05",
"last_updated": "2024-08-05",
"certification_date": "2024-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NV",
"license": "8085",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Reno, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.