Active NPI
Amanda Yj Kim, DDS
- General Practice Dentistry
- Los Angeles, CA
National Provider Identifier
1790309243
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 107393
- Practice address
- 714 Tiverton Ave
Los Angeles, CA 90095-8361 - Phone
- (408) 529-4423
- NPI assigned
- Jun 1, 2020
- Sex
- Female
- 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 | 107393 | CA | Primary |
Addresses
Primary practice location
714 Tiverton Ave
Los Angeles, CA 90095-8361
Mailing address
714 Tiverton Ave
Los Angeles, CA 90095-8361
Phone (310) 825-9295
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 |
|---|---|---|---|
| 107393 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590969600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706832000000",
"number": "1790309243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "714 TIVERTON AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900958361",
"telephone_number": "310-825-9295"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "714 TIVERTON AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900958361",
"telephone_number": "408-529-4423"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "AMANDA",
"middle_name": "YJ",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-06-01",
"last_updated": "2024-02-02",
"certification_date": "2024-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "107393",
"primary": true
}
],
"identifiers": [],
"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 Feb 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.