Active NPI
Louis Min Keun Kim, DDS
- General Practice Dentistry
- Sacramento, CA
National Provider Identifier
1992875603
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 53231
- Practice address
- 4730 47TH Ave
Sacramento, CA 95824-3959 - Phone
- (916) 391-0682
- Fax
- (916) 391-7059
- NPI assigned
- Nov 9, 2006
- 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 | 53231 | CA | Primary |
Addresses
Primary practice location
4730 47TH Ave
Sacramento, CA 95824-3959
Mailing address
15900 Ocean LN
Gardena, CA 90249-4659
Phone (310) 965-0343
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 |
|---|---|---|---|---|
| I20151112000380 | CA | Order and Referring Only - Dentist | 0042520561 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53231 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214352000000",
"number": "1992875603",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15900 OCEAN LN",
"city": "GARDENA",
"state": "CA",
"postal_code": "902494659",
"telephone_number": "310-965-0343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4730 47TH AVE",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958243959",
"telephone_number": "916-391-0682",
"fax_number": "916-391-7059"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "LOUIS",
"middle_name": "MIN KEUN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-09",
"last_updated": "2008-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "53231",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; 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.