Kwang Jin Kim, D.D.S

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

License

31300 Issued in CA

Practice address

3300 W Rosecrans Ave
Suite 105
Hawthorne, CA 90250-8218

Phone

(310) 679-3300

Fax

(310) 679-3932

NPI assigned

Jan 8, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Kwang Jin Kim DDS

  • Preferred Provider Organization
  • Hawthorne, CA
  • NPI 1992105142
  NPD (past) Authorized official
• Jason Kim Dental Corporation

  • Dental Clinic/Center
  • Hawthorne, CA
  • NPI 1346857943
  NPD (past)

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1578611356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2220 SMOKEWOOD AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928311107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 W ROSECRANS AVE",
            "address_2": "SUITE 105",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902508218",
            "telephone_number": "310-679-3300",
            "fax_number": "310-679-3932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "KWANG",
        "middle_name": "JIN",
        "name_prefix": "Mr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "CA",
            "license": "31300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL PROVIDER NUMBER",
            "identifier": "B-31300-02",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Whitley Killian
• Eunice Kim, PPS
• Harper Kim
• Hyun Young Kim
• James Myung Ju Kim, DDS
• Mark Sung-Kyoung Kim, M.D.
• Min Seok Kim, DDS
• Reynda J King
• Lisa Susan Kirschenbaum, MFT
• Arcelia Kiss, FNP

• Public Health Dentistry in Hawthorne, CA
• Providers in Hawthorne, CA by specialty
• Public Health Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.