Active NPI
Hyunjoon Kim, DDS
- Dentist
- San Leandro, CA
National Provider Identifier
1790455483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 106401
- Practice address
- 1598 Washington Ave
San Leandro, CA 94577-4465 - Phone
- (510) 545-4588
- NPI assigned
- Sep 15, 2021
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 106401 | CA | Primary |
Addresses
Primary practice location
1598 Washington Ave
San Leandro, CA 94577-4465
Mailing address
920 Bay St Apt 1
San Francisco, CA 94109-1152
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 |
|---|---|---|---|
| 106401 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631664000000",
"number": "1790455483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "920 BAY ST APT 1",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941091152"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1598 WASHINGTON AVE",
"city": "SAN LEANDRO",
"state": "CA",
"postal_code": "945774465",
"telephone_number": "510-545-4588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "HYUNJOON",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-09-15",
"last_updated": "2021-09-15",
"certification_date": "2021-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "CA",
"license": "106401",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Leandro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.