KEON-JUNG KIM PROFESSIONAL DENTAL CORPORATION (NPI# 1114132107) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114132107 |
| Entity Type | Organization |
| Organization Name | KEON-JUNG KIM PROFESSIONAL DENTAL CORPORATION |
| Practice Address |
3257 Camino De Los Coches #303 Carlsbad CA 92009-8966 |
| Practice Telephone | 7604799876 |
| Practice Fax Number | 7604790028 |
| Mailing Telephone | 7604799876 |
| Mailing Fax Number | 7604790028 |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2007-08-23 |
| Authorized Official Name | KEON-JUNG KIM (OWNER) |
| Authorized Official Telephone | 7604799876 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | Y |
| Parent Organization Name | KEON-JUNG KIM DENTAL CORP. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
47919 | CA | Ambulatory Health Care Facilities |
| Street Address |
3257 CAMINO DE LOS COCHES #303 |
| City | CARLSBAD |
| State | CA |
| Zip Code | 92009-8966 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356453781 | Gerald Miyamoto | Dentist | 3257 Camino De Los Coches, Suite 302, Carlsbad, CA 92009-8976 | 2006-08-31 |
| 1336527787 | Head To Toe Laser Centers PC | Obstetrics & Gynecology | 3257 Camino De Los Coches, Suite 203, Carlsbad, CA 92009-8976 | 2015-05-18 |
| 1386032993 | Head To Toe Laser Centers | Clinic/Center | 3257 Camino De Los Coches, #203, Carlsbad, CA 92009-8976 | 2015-01-05 |
| 1265783088 | P.a. Dabir Dds & Z.e.s. Cuisia | Dentist | 3257 Camino De Los Coches, Suite 304, Carlsbad, CA 92009-8974 | 2012-09-20 |
| 1952606527 | Chandra Nicole Mcatee | Reflexologist | 3257 Camino De Los Coches, Suite 203, Carlsbad, CA 92009-8976 | 2011-01-12 |
| 1992950646 | Lars Nielsen | Acupuncturist | 3257 Camino De Los Coches, Suite 203, Carlsbad, CA 92009-8976 | 2008-11-21 |
| 1619122363 | Maki Tanaka Nielsen | Acupuncturist | 3257 Camino De Los Coches, Suite 203, Carlsbad, CA 92009-8976 | 2008-11-21 |
| 1003069469 | Harmony Acupuncture and Wellness Center, Inc | Clinic/Center | 3257 Camino De Los Coches, Suite 203, Carlsbad, CA 92009-8976 | 2008-10-29 |
| 1598968810 | Jeffrey W Fruin | Dentist | 3257 Camino De Los Coches, #306, Carlsbad, CA 92009 | 2007-06-06 |
| 1164633459 | John W Fruin | Dentist | 3257 Camino De Los Coches, #306, Carlsbad, CA 92009 | 2007-05-25 |
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| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225523855 | Carlsbad Family Dentistry | Clinic/Center | 2010 Cassia Rd Ste 110, Carlsbad, CA 92009-4210 | 2018-06-26 |
| 1184968992 | Thirty-two Pearls Smile Spa | Clinic/Center | 114 W Fox St, Carlsbad, NM 88220-6212 | 2012-11-16 |
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| 1871995647 | Stephen A. Lawrence, Dds, Inc. | Clinic/Center | 785 Grand Ave, Suite 206, Carlsbad, CA 92008-2370 | 2014-09-23 |
| 1841628856 | Herbert S Woodward IIi Dds Inc | Clinic/Center | 325 Carlsbad Village Dr, Suite A-2, Carlsbad, CA 92008-2928 | 2013-10-30 |
| 1679801930 | Remodel Cosmetic Dentistry | Clinic/Center | 6221 Metropolitan St, Suite 102, Carlsbad, CA 92009-3096 | 2009-11-25 |
| 1083874424 | Maricelle R. Ortiz-luis, Dds, A Professional Corporation | Clinic/Center | 2515 Pio Pico Dr, Suite B, Carlsbad, CA 92008-1560 | 2008-06-10 |
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| 1912507948 | Alexander Phillips Dds Inc | Clinic/Center | 120 C Ave Ste 100, Coronado, CA 92118-1992 | 2020-10-28 |
| 1912507203 | George K Nguyen Dds, PC | Clinic/Center | 2097 Compton Ave Ste 104, Corona, CA 92881-7289 | 2020-10-27 |
| 1316547524 | Ingersoll Park Marina Gp Dental Corporation | Clinic/Center | 2301 Park Marina Dr Ste 27, Redding, CA 96001-2158 | 2020-10-27 |
| 1396344073 | Charles Kim Dental Corporation | Clinic/Center | 15651 Imperial Hwy Ste 204, La Mirada, CA 90638-1653 | 2020-10-22 |
| 1104425131 | Hossein Malakooti A Dental Corporation | Clinic/Center | 16540 Merrill Ave, Fontana, CA 92335 | 2020-10-21 |
| 1760081129 | Anthony Pham Dental Corp | Clinic/Center | 2658 E Garvey Ave S, West Covina, CA 91791-2113 | 2020-10-17 |
| 1215535182 | Park and Park Dental Group Partnership | Clinic/Center | 473 E Alessandro Blvd Ste A, Riverside, CA 92508-6021 | 2020-10-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.