Active NPI
Jin Young Kim, DDS, MS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Chino Hills, CA
National Provider Identifier
1629209341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 58103
- Practice address
- 5811 Pine Ave Ste B
Chino Hills, CA 91709-6541 - Phone
- (909) 393-4800
- Fax
- (888) 393-0564
- NPI assigned
- Jul 29, 2009
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 58103 | CA | Primary |
Addresses
Primary practice location
5811 Pine Ave Ste B
Chino Hills, CA 91709-6541
Mailing address
5811 Pine Ave Ste B
Chino Hills, CA 91709-6541
Phone (909) 393-4800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58103 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538092800000",
"number": "1629209341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5811 PINE AVE STE B",
"city": "CHINO HILLS",
"state": "CA",
"postal_code": "917096541",
"telephone_number": "909-393-4800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5811 PINE AVE STE B",
"city": "CHINO HILLS",
"state": "CA",
"postal_code": "917096541",
"telephone_number": "909-393-4800",
"fax_number": "888-393-0564"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JIN",
"middle_name": "YOUNG",
"name_prefix": "Dr.",
"credential": "DDS, MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-29",
"last_updated": "2018-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "CA",
"license": "58103",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chino Hills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.