Sophia Kim, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

61510 Issued in CA

Practice address

126 Avocado Ave Ste 202
Perris, CA 92571-2605

Phone

(951) 940-0202

NPI assigned

Jul 30, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Seulki Yang Other 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.

• Soonhyuk Chang DDS Inc

  • Dental Clinic/Center
  • Perris, CA
  • NPI 1457542516
  NPD (past)

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

{
    "created_epoch": "1343606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666569600000",
    "number": "1629324439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2120 S GLENWOOD AVE",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923244802",
            "telephone_number": "909-809-8873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 AVOCADO AVE STE 202",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925712605",
            "telephone_number": "951-940-0202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9810 Sierra Ave Ste D",
            "address_purpose": "LOCATION",
            "city": "Fontana",
            "state": "CA",
            "postal_code": "923356779",
            "country_code": "US",
            "telephone_number": "909-429-9090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "SOPHIA",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-30",
        "last_updated": "2022-10-24",
        "certification_date": "2022-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "61510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SEULKI",
            "last_name": "YANG",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Racheal Katherine Kerr
• Michael Keyes
• Mohammed Raheemuddin Khan, M.D.
• Yusra Khan, MD
• Chung Kim, D.D.S.
• Kevin King
• Sara Kirk, CCC-SLP
• Katie Knarreborg
• KND Development 54, L.L.C.
• KND Development 59 LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2022; 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.