Active NPI
Michael Kim, D.D.S.
- General Practice Dentistry
- Alta Loma, CA
National Provider Identifier
1881972644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 60509
- Practice address
- 7283 Carnelian St
Alta Loma, CA 91701-5526 - Phone
- (909) 987-6268
- Fax
- (909) 477-4509
- NPI assigned
- Jul 28, 2011
- Last updated
- Dec 10, 2012
- Sex
- Male
- Sole proprietor
- No
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 | 60509 | CA | Primary |
Addresses
Primary practice location
7283 Carnelian St
Alta Loma, CA 91701-5526
Mailing address
11203 Sunkist Dr
Loma Linda, CA 92354-6569
Phone (909) 799-7202
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ha Jung Kim Dental Corp | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355097600000",
"number": "1881972644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11203 SUNKIST DR",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923546569",
"telephone_number": "909-799-7202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7283 CARNELIAN ST",
"city": "ALTA LOMA",
"state": "CA",
"postal_code": "917015526",
"telephone_number": "909-987-6268",
"fax_number": "909-477-4509"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-07-28",
"last_updated": "2012-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "60509",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alta Loma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.