Jesse G Kim DDS Inc

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

JESSE G KIM DDS INC

Practice address

5168 Cumberland Dr
Cypress, CA 90630-3618

Phone

(408) 819-1709

NPI assigned

May 18, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Jesse Gawsung Kim, DDSNPI 1023398344

Title

Dentist

Phone

(408) 819-1709

Specialties & licenses 1

Addresses

Other names 1

• Jesse G Kim DDS Former legal business name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jesse Gawsung Kim, DDS

  • Dentist
  • Goleta, CA
  • NPI 1023398344
  NPD Authorized official

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

{
    "created_epoch": "1652832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655942400000",
    "number": "1578200804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5168 CUMBERLAND DR",
            "city": "CYPRESS",
            "state": "CA",
            "postal_code": "906303618",
            "telephone_number": "408-819-1709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5168 CUMBERLAND DR",
            "city": "CYPRESS",
            "state": "CA",
            "postal_code": "906303618",
            "telephone_number": "408-819-1709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESSE G KIM DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-18",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "GAWSUNG",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "408-819-1709",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jesse G Kim DDS",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Dental Clinic/Center in Cypress, CA
• Providers in Cypress, CA by specialty
• Dental Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.