Active NPI
Aileen Kim, D.D.S., M.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- West Covina, CA
National Provider Identifier
1689016255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 61307
- Practice address
- 933 S Sunset Ave
208
West Covina, CA 91790-3410 - Phone
- (626) 483-7714
- NPI assigned
- Jul 24, 2013
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 61307 | CA | Primary |
Addresses
Primary practice location
933 S Sunset Ave
208
West Covina, CA 91790-3410
Mailing address
1111 S Grand Ave Apt 706
Los Angeles, CA 90015-2169
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 |
|---|---|---|---|---|
| I20160118000328 | CA | Order and Referring Only - Dentist | 8022311570 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61307 | CA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393977600000",
"number": "1689016255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 S GRAND AVE APT 706",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900152169"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "933 S SUNSET AVE",
"address_2": "208",
"city": "WEST COVINA",
"state": "CA",
"postal_code": "917903410",
"telephone_number": "626-483-7714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "AILEEN",
"credential": "D.D.S., M.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-07-24",
"last_updated": "2014-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "CA",
"license": "61307",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Covina, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 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.