JD Kim Professional Dental Corp.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

JD KIM PROFESSIONAL DENTAL CORP.

Doing business as

Park Avenue Cosmetic Denistry

Practice address

1220 N Park Ave
Pomona, CA 91768-3029

Phone

(909) 397-9791

NPI assigned

Jun 5, 2019

Last updated

Sep 9, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Joo Hyung Hyung Kim, DDSNPI 1770002511

Title

Ceo/Dentist

Phone

(213) 595-1410

Specialties & licenses 1

Addresses

Other names 1

• Park Avenue Cosmetic Denistry Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joo Hyung Kim, DDS

  • Prosthodontics
  • Playa del Rey, CA
  • NPI 1770002511
  NPD Authorized official

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

{
    "created_epoch": "1559692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599609600000",
    "number": "1679131478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 N PARK AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917683029",
            "telephone_number": "909-397-9791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 N PARK AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917683029",
            "telephone_number": "909-397-9791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JD KIM PROFESSIONAL DENTAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-05",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JOO HYUNG",
        "authorized_official_middle_name": "HYUNG",
        "authorized_official_title_or_position": "CEO/DENTIST",
        "authorized_official_telephone_number": "213-595-1410",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Avenue Cosmetic Denistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Igsel Jasso
• Roxanne R. Jauregui
• Taylor Jauregui
• Michelle Jauwena
• Javan Dental Corporation
• La Kaisa Marie Jeanmarie
• Jeanne O Hunter DO
• Prasad Anjaneya Jeereddi, MD
• Praveena Jeereddi, MD
• Sudathi Jeereddi, MD

• General Practice Dentistry in Pomona, CA
• Providers in Pomona, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.