Active NPI
Sae Rom Kim
- Dentist
- Calexico, CA
National Provider Identifier
1457484438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 52739
- Practice address
- 2300 N Imperial Ave Ste E
Calexico, CA 92231-3209 - Phone
- (760) 357-1632
- NPI assigned
- Mar 13, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 52739 | CA | Primary |
Addresses
Primary practice location
2300 N Imperial Ave Ste E
Calexico, CA 92231-3209
Mailing address
25976 Lugo Dr
Loma Linda, CA 92354-6508
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 |
|---|---|---|---|
| 52739 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1457484438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25976 LUGO DR",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923546508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 N IMPERIAL AVE STE E",
"city": "CALEXICO",
"state": "CA",
"postal_code": "922313209",
"telephone_number": "760-357-1632"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SAE ROM",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "52739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Calexico, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.