Manyong Kim, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

41933 Issued in CA

Practice address

3533 E Chapman Ave Ste L
Orange, CA 92869-3850

Phone

(714) 744-6000

Fax

(714) 771-7900

NPI assigned

Sep 12, 2008

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 names 1

• Dr. Peter M( Manyong) Kim Professional name

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

State licenses

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.

• J&Y Dental Group Inc

  • General Practice Dentistry
  • Orange, CA
  • NPI 1821845041
  NPD (past)

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

{
    "created_epoch": "1221177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221177600000",
    "number": "1578712758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3533 E CHAPMAN AVE STE L",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928693850",
            "telephone_number": "714-744-6000",
            "fax_number": "714-771-7900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3533 E CHAPMAN AVE STE L",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928693850",
            "telephone_number": "714-744-6000",
            "fax_number": "714-771-7900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MANYONG",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-12",
        "last_updated": "2008-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "41933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PETER",
            "last_name": "KIM",
            "middle_name": "M( MANYONG)",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Kristin Kim, FNP
• Krystal Yuri Kim
• Leslie Jinha Kim
• Lisa Kim, NP
• Lori S Kim, MD
• Margaret Kim, BSN, RN
• Mark Honest Kim, MD
• Michael Kim, M.D.
• Michael Jevin Kim, M.D.
• Michael M Kim, M.D.

• Dentist in Orange, CA
• Providers in Orange, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2008; 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.