Priyawat and Kim Dental Services

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

Legal business name

PRIYAWAT AND KIM DENTAL SERVICES

Practice address

15911 Pomona Rincon Rd Ste 120
Chino Hills, CA 91709-5567

Phone

(909) 497-9449

Fax

(844) 600-4099

NPI assigned

May 25, 2021

Organization subpart

No

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

Authorized official

Name

Mr. Carrick Bannatz

Title

Office Manager

Phone

(909) 497-9449

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Omnia Dental Care Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Maria Kim, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Chino Hills, CA
  • NPI 1053778241

  General Practice

  Medicare reassignment NPD
• Rupporn Priyawat

  • Oral and Maxillofacial Surgery (Dentist)
  • Chino Hills, CA
  • NPI 1033453667
  Medicare reassignment NPD
• Paul Taehyung Kim, DDS

  • Dentist
  • Fullerton, CA
  • NPI 1982002531
  NPD
• Janet Hojung Kim, D.D.S

  • Dentist
  • Fullerton, CA
  • NPI 1104131101
  NPD (past)
• Catherine Reyes Manahan, D.D.S.

  • Dentist
  • Chino Hills, CA
  • NPI 1619320041
  NPD (past)

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

{
    "created_epoch": "1621900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692662400000",
    "number": "1801461561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15911 POMONA RINCON RD STE 120",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917095567",
            "telephone_number": "909-497-9449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15911 POMONA RINCON RD STE 120",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917095567",
            "telephone_number": "909-497-9449",
            "fax_number": "844-600-4099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "444 N Harbor Blvd Ste 240",
            "address_purpose": "LOCATION",
            "city": "Fullerton",
            "state": "CA",
            "postal_code": "928321968",
            "country_code": "US",
            "telephone_number": "714-519-3601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRIYAWAT AND KIM DENTAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-25",
        "last_updated": "2023-08-22",
        "certification_date": "2021-06-30",
        "status": "A",
        "authorized_official_last_name": "BANNATZ",
        "authorized_official_first_name": "CARRICK",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "909-497-9449",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "65123",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Omnia Dental Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Omnia Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Preferred Acupuncture Services, Inc.
• Premier Family Medicine Associates, Inc
• Ann Prieto
• Geraldine Vanessa Prieto
• Prime RX Chino Hills Inc
• Priyawat Dental Group Inc
• Rupporn Priyawat
• Pro-Body Orthopaedic & Sports Physical Therapy, Inc.
• Prototypes
• Geoffrey Putnam, MA BCBA

• Oral and Maxillofacial Surgery Clinic/Center in Chino Hills, CA
• Providers in Chino Hills, CA by specialty
• Oral and Maxillofacial Surgery Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.