Active NPI
Eugene Duejin Kim, D.D.S.
- Prosthodontics
- Buena Park, CA
National Provider Identifier
1609051838
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 43539
- Practice address
- 5861 Beach Blvd
Buena Park, CA 90621-2021 - Phone
- (714) 994-2501
- Fax
- (714) 994-2510
- NPI assigned
- Jan 7, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 43539 | CA | Primary |
Addresses
Primary practice location
5861 Beach Blvd
Buena Park, CA 90621-2021
Mailing address
5861 Beach Blvd
Buena Park, CA 90621-2021
Phone (714) 994-2501
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 |
|---|---|---|---|---|
| I20170217001097 | CA | Order and Referring Only - Dentist | 3971886961 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43539 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395273600000",
"number": "1609051838",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5861 BEACH BLVD",
"city": "BUENA PARK",
"state": "CA",
"postal_code": "906212021",
"telephone_number": "714-994-2501",
"fax_number": "714-994-2510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5861 BEACH BLVD",
"city": "BUENA PARK",
"state": "CA",
"postal_code": "906212021",
"telephone_number": "714-994-2501",
"fax_number": "714-994-2510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "EUGENE",
"middle_name": "DUEJIN",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-01-07",
"last_updated": "2014-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "CA",
"license": "43539",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buena Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2014; 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.