Active NPI
Kimberly Coronel, RDA
- Dental Assistant
- Los Angeles, CA
National Provider Identifier
1750872750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- 82811
- Practice address
- 12121 Wilshire Blvd Ste 1111
Los Angeles, CA 90025-1188 - Phone
- (310) 820-9933
- NPI assigned
- May 24, 2018
- 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 |
|---|---|---|---|---|
| Dental Assistant | 126800000X | 82811 | CA | Primary |
Addresses
Primary practice location
12121 Wilshire Blvd Ste 1111
Los Angeles, CA 90025-1188
Mailing address
5480 Orange Ave Apt 4
Long Beach, CA 90805-6162
Phone (562) 541-4277
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 82811 | Other | CA | DENTAL BOARD OF CALIFORNIA |
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 |
|---|---|---|---|
| 82811 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529107200000",
"number": "1750872750",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5480 ORANGE AVE APT 4",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908056162",
"telephone_number": "562-541-4277"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12121 WILSHIRE BLVD STE 1111",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900251188",
"telephone_number": "310-820-9933"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORONEL",
"first_name": "KIMBERLY",
"credential": "RDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-24",
"last_updated": "2018-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "CA",
"license": "82811",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL BOARD OF CALIFORNIA",
"identifier": "82811",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.