Active NPI
Sara Kim, DMD
- Dentist
- Compton, CA
National Provider Identifier
1679214480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 107667
- Practice address
- 821 W Rosecrans Ave
Compton, CA 90222-3821 - Phone
- (310) 604-4000
- NPI assigned
- Apr 5, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 107667 | CA | Primary |
Addresses
Primary practice location
821 W Rosecrans Ave
Compton, CA 90222-3821
Mailing address
350 N Clark St Ste 600
Chicago, IL 60654-4782
Other practice location 1
350 N Clark St Ste 600
Chicago, IL 60654-4782
Phone (312) 274-0308
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107667 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661990400000",
"number": "1679214480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 N CLARK ST STE 600",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606544782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "821 W ROSECRANS AVE",
"city": "COMPTON",
"state": "CA",
"postal_code": "902223821",
"telephone_number": "310-604-4000"
}
],
"practiceLocations": [
{
"address_1": "350 N Clark St Ste 600",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606544782",
"country_code": "US",
"telephone_number": "312-274-0308",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIM",
"first_name": "SARA",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-04-05",
"last_updated": "2022-09-01",
"certification_date": "2022-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "107667",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Compton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.