Active NPI
Chanyoung Kim
- General Practice Dentistry
- Loma Linda, CA
National Provider Identifier
1811668122
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 106313
- Practice address
- 25022 Prospect Ave Apt B
Loma Linda, CA 92354-2955 - Phone
- (951) 776-6037
- NPI assigned
- Sep 26, 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 106313 | CA | Primary |
Addresses
Primary practice location
25022 Prospect Ave Apt B
Loma Linda, CA 92354-2955
Mailing address
25022 Prospect Ave Apt B
Loma Linda, CA 92354-2955
Phone (951) 776-6037
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 |
|---|---|---|---|
| 106313 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632614400000",
"number": "1811668122",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25022 PROSPECT AVE APT B",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923542955",
"telephone_number": "951-776-6037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25022 PROSPECT AVE APT B",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923542955",
"telephone_number": "951-776-6037"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "CHANYOUNG",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-09-26",
"last_updated": "2021-09-26",
"certification_date": "2021-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "106313",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Loma Linda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.