Active NPI
Eugenie Heo Kim, DDS
- Dentist
- Hesperia, CA
National Provider Identifier
1487096699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 62603
- Practice address
- 14661 Main St
Hesperia, CA 92345-3308 - Phone
- (909) 522-0163
- Fax
- (760) 244-6199
- NPI assigned
- Jul 29, 2013
- Sex
- Female
- Sole proprietor
- No
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 | 62603 | CA | Primary |
Addresses
Primary practice location
14661 Main St
Hesperia, CA 92345-3308
Mailing address
14661 Main St
Hesperia, CA 92345-3308
Phone (909) 522-0163
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460332800000",
"number": "1487096699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14661 MAIN ST",
"city": "HESPERIA",
"state": "CA",
"postal_code": "923453308",
"telephone_number": "909-522-0163",
"fax_number": "760-244-6199"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14661 MAIN ST",
"city": "HESPERIA",
"state": "CA",
"postal_code": "923453308",
"telephone_number": "909-522-0163",
"fax_number": "760-244-6199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "EUGENIE",
"middle_name": "HEO",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-07-29",
"last_updated": "2016-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "62603",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hesperia, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.