Active NPI
Ben Yong-Il Kim, DDS
- Dentist
- Martinez, CA
National Provider Identifier
1962685461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS0491210
- Practice address
- 2500 Alhambra Ave
Martinez, CA 94553-3156 - Phone
- (925) 788-5081
- Fax
- (925) 431-2506
- NPI assigned
- Dec 7, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DS0491210 | CA | Primary |
Addresses
Primary practice location
2500 Alhambra Ave
Martinez, CA 94553-3156
Mailing address
14 Village Square PL
Pleasant Hill, CA 94523-4388
Phone (925) 788-5081
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180629001723 | CA | Order and Referring Only - Dentist | 1456607621 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49121 | CA | MD | Marriage & Family Therapist |
| DS0491210 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378339200000",
"number": "1962685461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 VILLAGE SQUARE PL",
"city": "PLEASANT HILL",
"state": "CA",
"postal_code": "945234388",
"telephone_number": "925-788-5081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 ALHAMBRA AVE",
"city": "MARTINEZ",
"state": "CA",
"postal_code": "945533156",
"telephone_number": "925-788-5081",
"fax_number": "925-431-2506"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "BEN",
"middle_name": "YONG-IL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-07",
"last_updated": "2013-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "DS0491210",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Martinez, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2013; 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.