Han S. Kim, DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

65331 Issued in CA

Practice address

2480 Llewellyn Ave
Fort Meade, MD 20755-7081

Phone

(310) 993-1836

NPI assigned

Aug 10, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Clinicas del Camino Real Inc

  dba Clinicas del Camino Real, Inc., Paseo Camarillo

  • Federally Qualified Health Center (FQHC)
  • Camarillo, CA
  • NPI 1295297190
  NPD (past)
• Clinicas del Camino Real Inc

  dba Clinicas del Camino Real, Inc., La Colonia

  • Federally Qualified Health Center (FQHC)
  • Oxnard, CA
  • NPI 1942789359
  NPD (past)

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

{
    "created_epoch": "1470787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755561600000",
    "number": "1861946683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 FLYNN RD",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930125092",
            "telephone_number": "805-673-3930",
            "fax_number": "805-659-3217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2480 LLEWELLYN AVE",
            "city": "FORT MEADE",
            "state": "MD",
            "postal_code": "207557081",
            "telephone_number": "310-993-1836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "HAN",
        "middle_name": "S.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-10",
        "last_updated": "2025-08-19",
        "certification_date": "2025-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "65331",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "65331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bonita Louise Jude, MD
• Kacc
• Kathryn L Kassim, MS, OTR/L, CHT
• Adam T Keres, D.C.
• Chunhui J Kim, RN, BSN, COHN-S
• Jiye Kim, PHARMD
• Kimbrough Acc Military MTF (Usadc Epes-Meade)
• Kimbrough Acc Military MTF (Usadc-3-Meade)
• Kimbrough Ambulatory Care Center
• Kimbrough Ambulatory Care Center

• Periodontics in Fort Meade, MD
• Providers in Fort Meade, MD by specialty
• Periodontics in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2025; 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.

Verify at the official NPI Registry.