Active NPI
Grace Kim
- Pediatric Dentistry
- Menifee, CA
National Provider Identifier
1710448766
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DDS107335
- Practice address
- 29950 Haun Rd Ste 302
Menifee, CA 92586-6527 - Phone
- (951) 679-1667
- NPI assigned
- Mar 30, 2019
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DDS107335 | CA | Primary |
Addresses
Primary practice location
29950 Haun Rd Ste 302
Menifee, CA 92586-6527
Mailing address
12626 Crossdale Ave
Norwalk, CA 90650-2671
Phone (562) 565-7021
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 |
|---|---|---|---|
| DDS107335 | CA | MD | Pediatric Dentist |
Interoperability endpoints
- grace.kim.p1@direct.wcchc.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655942400000",
"number": "1710448766",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12626 CROSSDALE AVE",
"city": "NORWALK",
"state": "CA",
"postal_code": "906502671",
"telephone_number": "562-565-7021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29950 HAUN RD STE 302",
"city": "MENIFEE",
"state": "CA",
"postal_code": "925866527",
"telephone_number": "951-679-1667"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "GRACE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-30",
"last_updated": "2022-06-23",
"certification_date": "2022-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "DDS107335",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Menifee, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 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.