Individual provider Active NPI

Rosa Kim Le, DDS

  • Dentist
  • Littleton, CO
National Provider Identifier
1477092633
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
105045 Issued in CA
Practice address
8199 Southpark LN Ste 120
Littleton, CO 80120-5665
Phone
(303) 738-8826
NPI assigned
Feb 20, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 203510 CO
Dentist 122300000X 105045 CA Primary

Addresses

Primary practice location

8199 Southpark LN Ste 120
Littleton, CO 80120-5665

Mailing address

1726 Champa St Apt 5E
Denver, CO 80202-2716
Phone (408) 646-5368

Other practice location 1

9250 E Hampden Ave # 100
Denver, CO 80231-5413
Phone (303) 980-8888

Other practice location 2

1809 National Ave
San Diego, CA 92113-2113
Phone (619) 515-2300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210618000953 CA Practitioner - Dentist 9537569108 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
105045CAMDDentist
203510COMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers of San Diego, Inc Current Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Jun 11, 2021 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Jun 11, 2021 Accepting new patients

Locations

1809 National Ave
San Diego, CA 92113
Phone (619) 515-2500

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1487548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1477092633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1726 CHAMPA ST APT 5E",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802022716",
            "telephone_number": "408-646-5368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8199 SOUTHPARK LN STE 120",
            "city": "LITTLETON",
            "state": "CO",
            "postal_code": "801205665",
            "telephone_number": "303-738-8826"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9250 E Hampden Ave # 100",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802315413",
            "country_code": "US",
            "telephone_number": "303-980-8888",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1809 National Ave",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921132113",
            "country_code": "US",
            "telephone_number": "619-515-2300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LE",
        "first_name": "ROSA",
        "middle_name": "KIM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-20",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "203510",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "105045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Littleton, CO

Sources for this page

Verify at the official NPI Registry.