Active NPI
Grace Kim
- General Practice Dentistry
- San Pedro, CA
National Provider Identifier
1538052196
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 111597
- Practice address
- 425 S Pacific Ave
San Pedro, CA 90731-2625 - Phone
- (310) 547-0202
- NPI assigned
- Jun 2, 2025
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 111597 | CA | Primary |
Addresses
Primary practice location
425 S Pacific Ave
San Pedro, CA 90731-2625
Mailing address
205D Evans St Apt 4
Buffalo, NY 14221-5618
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250808001903 | CA | Order and Referring Only - Dentist | 6800394867 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Interoperability endpoints
- grace.kim.p1@direct.cscla.nextgenshare.com
- grace.kim.1@28334.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1748822400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748822400000",
"number": "1538052196",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205D EVANS ST APT 4",
"city": "BUFFALO",
"state": "NY",
"postal_code": "142215618"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 S PACIFIC AVE",
"city": "SAN PEDRO",
"state": "CA",
"postal_code": "907312625",
"telephone_number": "310-547-0202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "GRACE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-06-02",
"last_updated": "2025-06-02",
"certification_date": "2025-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "111597",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Pedro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.