Dr. Jeffrey J Kim's Dental, Inc.

Primary specialty

DentistTaxonomy code 122300000X

License

40252 Issued in CA

Legal business name

DR. JEFFREY J KIM'S DENTAL, INC.

Practice address

784 N D Street
San Bernardino, CA 92401

Phone

(909) 884-4733

Fax

(909) 884-0668

NPI assigned

Mar 22, 2007

Last updated

Jun 29, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jeffrey J KimNPI 1851550248

Title

Owner

Phone

(909) 884-4733

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeffrey J Kim, DDS

  • Dentist
  • San Bernardino, CA
  • NPI 1851550248
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467158400000",
    "number": "1841316437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "784 N D STREET",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92401",
            "telephone_number": "909-884-4733",
            "fax_number": "909-884-0668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "784 N D STREET",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92401",
            "telephone_number": "909-884-4733",
            "fax_number": "909-884-0668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. JEFFREY J KIM'S DENTAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2016-06-29",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-884-4733",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "40252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2016; 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.