{
"Npi": {
"NPI": "1851027254",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KIM",
"FirstName": "KI BUM",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "KIM",
"OtherFirstName": "KEVIN",
"OtherMiddleName": "KB",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "DMD",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "6726 LIMONITE CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CARLSBAD",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92009-5202",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "760-809-5061",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6726 LIMONITE CT",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CARLSBAD",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92009-5202",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-809-5061",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/27/2022",
"LastUpdateDate": "03/26/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "019.033884",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "DE61172402",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "108481",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}