Active NPI
Jennifer Eunji Kim, DDS
- Dentist
- San Jose, CA
National Provider Identifier
1790217115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 103237
- Practice address
- 1170 Lockhaven Way
San Jose, CA 95129-4031 - Phone
- (408) 892-0223
- NPI assigned
- Apr 3, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | 103237 | CA | Primary |
Addresses
Primary practice location
1170 Lockhaven Way
San Jose, CA 95129-4031
Mailing address
200 Belle Terre Rd
Port Jefferson, NY 11777-1928
Phone (631) 474-6553
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 |
|---|---|---|---|
| 103237 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540339200000",
"number": "1790217115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 BELLE TERRE RD",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117771928",
"telephone_number": "631-474-6553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1170 LOCKHAVEN WAY",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951294031",
"telephone_number": "408-892-0223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JENNIFER",
"middle_name": "EUNJI",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-04-03",
"last_updated": "2018-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "103237",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 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.