Active NPI
Donghan Kim, DDS
- General Practice Dentistry
- Rancho Cucamonga, CA
National Provider Identifier
1801319157
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 100847
- Practice address
- 7333 Hellman Ave
Rancho Cucamonga, CA 91730-1302 - Phone
- (909) 483-0600
- NPI assigned
- Jul 19, 2017
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 100847 | CA | Primary |
Addresses
Primary practice location
7333 Hellman Ave
Rancho Cucamonga, CA 91730-1302
Mailing address
14861 Maplewood Dr
Chino Hills, CA 91709-5184
Phone (678) 900-5183
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170822002185 | CA | Order and Referring Only - Oral Surgery | 8022380344 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500422400000",
"number": "1801319157",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14861 MAPLEWOOD DR",
"city": "CHINO HILLS",
"state": "CA",
"postal_code": "917095184",
"telephone_number": "678-900-5183"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7333 HELLMAN AVE",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917301302",
"telephone_number": "909-483-0600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "DONGHAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-07-19",
"last_updated": "2017-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "100847",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Cucamonga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2017; 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.