Active NPI
Kosal Kom, D.D.S.
- General Practice Dentistry
- Long Beach, CA
National Provider Identifier
1710034566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 41442
- Practice address
- 2338 E Anaheim St
Suite 108
Long Beach, CA 90804-5730 - Phone
- (562) 434-9980
- NPI assigned
- Jan 4, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 41442 | CA | Primary |
Addresses
Primary practice location
2338 E Anaheim St
Suite 108
Long Beach, CA 90804-5730
Mailing address
2338 E Anaheim St
Suite 108
Long Beach, CA 90804-5730
Phone (562) 434-9980
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 |
|---|---|---|---|
| 41442 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kosal Kom, DDS, Inc | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Long Beach, CA
- NPI 1689805012
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710034566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2338 E ANAHEIM ST",
"address_2": "SUITE 108",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908045730",
"telephone_number": "562-434-9980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2338 E ANAHEIM ST",
"address_2": "SUITE 108",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908045730",
"telephone_number": "562-434-9980"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOM",
"first_name": "KOSAL",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "41442",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.