Brandon Young Joon Kim, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

108899 Issued in CA

Practice address

1850 S Waterman Ste B
San Bernardino, CA 92408

Phone

(909) 890-1529

NPI assigned

Jun 26, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Johnathan Hyun Kim DDS, Inc.

  • Dental Clinic/Center
  • San Bernardino, CA
  • NPI 1437809233
  NPD
• Johnathan Kim D.D.S. Dental Practice

  • Dental Clinic/Center
  • Redlands, CA
  • NPI 1184335754
  NPD

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

{
    "created_epoch": "1687737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687737600000",
    "number": "1861178741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10927 SUNNY COVE CT",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "92373",
            "telephone_number": "805-305-0826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 S WATERMAN STE B",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92408",
            "telephone_number": "909-890-1529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "BRANDON",
        "middle_name": "YOUNG JOON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-26",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "108899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Divyakant J Kikani, M.D.
• Paul Kil, FNP-C
• Mitsu Marie Killion, P.A.-C
• Anna Kim
• Billy Young Kim, PA-C
• Brian Chong-Han Kim, D.D.S.
• Chaelin Kim, L.AC.
• Dae Yeon Kim, FNP-C
• Daniel Kim, P.A.
• Daniel E Kim, PA-C

• General Practice Dentistry in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.