Chung Kim, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

26442 Issued in CA

Practice address

204 E Warner Ave Ste 104
Santa Ana, CA 92707-3277

Phone

(714) 641-2939

Fax

(714) 641-2868

NPI assigned

Aug 22, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Chung Kim Dental Corporation

  • Dentist
  • Santa Ana, CA
  • NPI 1558553511
  NPD (past) Authorized official
• Tu-Uyen Phuoc Nguyen, D.D.S., Dental Corporation

  • Dentist
  • Santa Ana, CA
  • NPI 1750297743
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187740800000",
    "number": "1801089925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 E WARNER AVE STE 104",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927073277",
            "telephone_number": "714-641-2939",
            "fax_number": "714-641-2868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 E WARNER AVE STE 104",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927073277",
            "telephone_number": "714-641-2939",
            "fax_number": "714-641-2868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "CHUNG",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-22",
        "last_updated": "2007-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "26442",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTI-CAL",
            "identifier": "D26442",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Austin Kim, BEHAVIOR TECHNICAN
• Bouree Kim
• Chae Hyun Kim, DDS
• Chae Jin Kim, DDS
• Christina Kim, FNP-C
• Dain Kim, BEHAVIOR TECHNICIAN
• Daniel Dong Gun Kim
• David S Kim, BT
• Deborah Kim, DO, MPH
• Diane Kim, MD

• Dentist in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.