1003950627 NPI number — DR. ROSE E KIM DDS

Table of content: DR. ROSE E KIM DDS (NPI 1003950627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003950627 NPI number — DR. ROSE E KIM DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
ROSE
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003950627
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27885 SMYTH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALENCIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91355-4011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-294-1800
Provider Business Mailing Address Fax Number:
661-294-9774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27885 SMYTH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALENCIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91355-4011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-294-1800
Provider Business Practice Location Address Fax Number:
661-294-9774
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  39025 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 954652626 . This is a "GOLDEN WEST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 954652626 . This is a "ANTHEM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 954652626 . This is a "CORE SOURCE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 954652626 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 954652626 . This is a "AETNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 954652626 . This is a "WASHINGTON DENTAL SERVICE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 954652626 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 954652626 . This is a "ASSURANT EMPLOYEE BENEFIT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 954652626 . This is a "DELTA DENTAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 273749 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 954652626 . This is a "FORTIS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 954652626 . This is a "PACIFIC CARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 954652626 . This is a "GENWORTH FINANCIAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 954652626 . This is a "EBA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 954652626 . This is a "CONNECTICUT GENERAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 954652626 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 954652626 . This is a "CARPENTERS HEALTH & WELFA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 954652626 . This is a "DELTA USA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 954652626 . This is a "MET LIFE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com