Soodong Kim, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

38859 Issued in CA

Practice address

1728 N D St
San Bernardino, CA 92405-4418

Phone

(909) 886-0087

Fax

(909) 886-3533

NPI assigned

Jan 25, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Woo Yong Lee DDS Inc

  • Dental Clinic/Center
  • San Bernardino, CA
  • NPI 1790374791
  NPD (past)

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1689720740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2615 CANADA BLVD",
            "address_2": "#303",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912082076",
            "telephone_number": "818-247-2327",
            "fax_number": "909-886-3533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1728 N D ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924054418",
            "telephone_number": "909-886-0087",
            "fax_number": "909-886-3533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SOODONG",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "38859",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA HEALTHY FAMILY",
            "identifier": "B38859-01",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G94047-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jiyeon Kim, L.AC
• Jungbum Kim
• Katie Y. Kim
• Paul Seung Ki Kim, M.D.
• Prisca Kim
• Stephanie Mijoo Kim
• Sun Ik Kim, MD
• Sunny Eun Kim
• Young Min Kim, M.D.
• Younglee Kim, RN

• General Practice Dentistry in San Bernardino, CA
• Providers in San Bernardino, 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 Jul 9, 2007; 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.