Active NPI
Won Young Kim, D.D.S
- Dentist
- Loma Linda, CA
National Provider Identifier
1740737550
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DDS100455
- Practice address
- 11064 Mesquite Ave
Loma Linda, CA 92354 - Phone
- (269) 277-3847
- NPI assigned
- Sep 9, 2016
- Sex
- Male
- 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 | DDS100455 | CA | Primary |
Addresses
Primary practice location
11064 Mesquite Ave
Loma Linda, CA 92354
Mailing address
11064 Mesquite Ave
Loma Linda, CA 92354-6555
Phone (269) 277-3847
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100455 | CA | MD | Clinical Social Worker |
| DDS100455 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473379200000",
"number": "1740737550",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11064 MESQUITE AVE",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923546555",
"telephone_number": "269-277-3847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11064 MESQUITE AVE",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "92354",
"telephone_number": "269-277-3847"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "WON YOUNG",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-09-09",
"last_updated": "2016-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "DDS100455",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Loma Linda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.