Justin Yunouk Kim, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

86493 Issued in CA

Practice address

301 E Buena Vista St
Barstow, CA 92311-2803

Phone

(760) 460-4999

NPI assigned

Oct 9, 2020

Sex

Male

Sole proprietor

Yes

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

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

{
    "created_epoch": "1602201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602201600000",
    "number": "1447858766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11431 MAGNOLIA AVE APT 106",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925054812",
            "telephone_number": "917-838-8701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E BUENA VISTA ST",
            "city": "BARSTOW",
            "state": "CA",
            "postal_code": "923112803",
            "telephone_number": "760-460-4999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "126 Avocado Ave Ste 202",
            "address_purpose": "LOCATION",
            "city": "Perris",
            "state": "CA",
            "postal_code": "925712605",
            "country_code": "US",
            "telephone_number": "951-345-4340",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "JUSTIN",
        "middle_name": "YUNOUK",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-10-09",
        "last_updated": "2020-10-09",
        "certification_date": "2020-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "86493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dawnelle Y Keys
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• Michael K Klein, MD
• Angie Marie Koelle, BSN, RN
• Michelle Marie Kooiman, NP-C
• Denise Kuhn, MPT

• General Practice Dentistry in Barstow, CA
• Providers in Barstow, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2020; 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.