Ra and Kim Dental Corp

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

RA AND KIM DENTAL CORP

Doing business as

Lakeside Dental Group

Practice address

42002 Fox Farm Road #101
Big Bear Lake, CA 92315-6951

Phone

(909) 866-0606

Fax

(909) 866-5546

NPI assigned

Mar 20, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Phil Jae Ra, D.D.S.

Title

Dentist

Phone

(909) 866-0606

Specialties & licenses 1

Addresses

Other names 1

• Lakeside Dental Group Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• James H Kim, D.D.S.

  • General Practice Dentistry
  • Big Bear Lake, CA
  • NPI 1982720751
  NPD (past)

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457476137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6951",
            "address_2": "42002 FOX FARM ROAD #101",
            "city": "BIG BEAR LAKE",
            "state": "CA",
            "postal_code": "923156951",
            "telephone_number": "909-866-0606",
            "fax_number": "909-866-5546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42002 FOX FARM ROAD #101",
            "city": "BIG BEAR LAKE",
            "state": "CA",
            "postal_code": "923156951",
            "telephone_number": "909-866-0606",
            "fax_number": "909-866-5546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RA AND KIM DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RA",
        "authorized_official_first_name": "PHIL",
        "authorized_official_middle_name": "JAE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "909-866-0606",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katheryn Poole, DDS
• Dolores Christine Price, CATC
• Rosemary Proff, FNP-C
• Lydia Marie Quick
• R & M Dental Management Co (Big Bear Dental Center)
• Vigil Beth Solidum Rapiz, PHARMD, MHA, MPA
• Cheyenne Meriah Reyes
• Sherrill Lynn Reynolds, LCSW
• Leron Samuel Ribeiro-West, ACSW
• Patrick Russell Rice

• Dentist in Big Bear Lake, CA
• Providers in Big Bear Lake, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.