Active NPI
Saewon Kim
- Dentist
- Palmdale, CA
National Provider Identifier
1962196840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 112156
- Practice address
- 510 W Rancho Vista Blvd
Palmdale, CA 93551-3737 - Phone
- (661) 202-3052
- NPI assigned
- Jun 5, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 112156 | CA | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
510 W Rancho Vista Blvd
Palmdale, CA 93551-3737
Mailing address
365 Blackshear Ave
East Los Angeles, CA 90022-2307
Phone (323) 326-8186
Other practice location 1
1980 N Columbia St
Milledgeville, GA 31061-2020
Phone (478) 387-7015
Other practice location 2
16111 Plummer St
North Hills, CA 91343-2036
Phone (818) 891-7711
Other practice location 3
11301 Wilshire Blvd
Los Angeles, CA 90073-1003
Phone (310) 478-3711
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 |
|---|---|---|---|
| 112156 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757980800000",
"number": "1962196840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "365 BLACKSHEAR AVE",
"city": "EAST LOS ANGELES",
"state": "CA",
"postal_code": "900222307",
"telephone_number": "323-326-8186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 W RANCHO VISTA BLVD",
"city": "PALMDALE",
"state": "CA",
"postal_code": "935513737",
"telephone_number": "661-202-3052"
}
],
"practiceLocations": [
{
"address_1": "1980 N Columbia St",
"address_purpose": "LOCATION",
"city": "Milledgeville",
"state": "GA",
"postal_code": "310612020",
"country_code": "US",
"telephone_number": "478-387-7015",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "16111 Plummer St",
"address_purpose": "LOCATION",
"city": "North Hills",
"state": "CA",
"postal_code": "913432036",
"country_code": "US",
"telephone_number": "818-891-7711",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "11301 Wilshire Blvd",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900731003",
"country_code": "US",
"telephone_number": "310-478-3711",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIM",
"first_name": "SAEWON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-05",
"last_updated": "2025-09-16",
"certification_date": "2025-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "112156",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palmdale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.