Katie Kim, DDS

Key facts

NPI

1467918508

Entity type

Individual (NPI type 1)

Primary specialty

Pediatric Dentistry 1223P0221X

License

106104 (CA)

Practice address

3501 School St
Lafayette, CA 94549-4505

Phone

(925) 385-8051

NPI assigned

Feb 13, 2019

Sex

Female

Sole proprietor

No

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.

• Barnali Roy, DDS, Inc Dental Clinic/Center · Lafayette, CA · NPI 1194190967
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 28, 2023.

{
    "created_epoch": "1550016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674864000000",
    "number": "1467918508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2999 BOWERY LN",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951351543",
            "telephone_number": "408-499-8287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 SCHOOL ST",
            "city": "LAFAYETTE",
            "state": "CA",
            "postal_code": "945494505",
            "telephone_number": "925-385-8051"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4401 Penn Ave",
            "address_2": "3rd Floor Bear Pod",
            "address_purpose": "LOCATION",
            "city": "Pittsburgh",
            "state": "PA",
            "postal_code": "152241334",
            "country_code": "US",
            "telephone_number": "412-692-7831",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "KATIE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-13",
        "last_updated": "2023-01-28",
        "certification_date": "2023-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "106104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, CA

• Kimberly Dawn Kerlin, M.A., LMFT
• Kevin Ko, a Professional Dental Corporation
• Aimee Keyashian, MD
• William Barry Kievning, PHYSICAL THERAPIST
• John Hyun-Suk Kim, D.D.S.
• Yeunjoo Kim
• Edward Craig Klass, PT
• Bethany Kleine
• Marguerite Vance Knudtson, L.AC.
• Kevin Kinghang Ko, D.D.S.

All providers in Lafayette, CA · Pediatric Dentistry in California