Kelly Yeon Su Kim, DDS - Medicare Dentist in Laguna Niguel, CA

Kelly Yeon Su Kim, DDS is a medicare enrolled "Dentist - Pediatric Dentistry" provider in Laguna Niguel, California. Her current practice location is 30001 Crown Valley Pkwy, Suite G, Laguna Niguel, California. You can reach out to her office (for appointments etc.) via phone at (949) 495-4245.

Kelly Yeon Su Kim is licensed to practice in California (license number 58075) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1053625715.

Contact Information

Kelly Yeon Su Kim, DDS
30001 Crown Valley Pkwy, Suite G,
Laguna Niguel, CA 92677-1723
(949) 495-4245
Not Available



Healthcare Provider's Profile

Full NameKelly Yeon Su Kim
GenderFemale
SpecialityDentist - Pediatric Dentistry
Location30001 Crown Valley Pkwy, Laguna Niguel, California
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1053625715
  • Provider Enumeration Date: 08/04/2010
  • Last Update Date: 06/16/2011
  Medicare PECOS Information:
  • PECOS PAC ID: 7214242825
  • Enrollment ID: I20150811005650

Medical Identifiers

Medical identifiers for Kelly Yeon Su Kim such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1053625715NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
1223P0221XDentist - Pediatric Dentistry 58075 (California)Primary
1223P0221XDentist - Pediatric Dentistry 055114 (New York)Secondary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kelly Yeon Su Kim is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Kelly Yeon Su Kim, DDS
30001 Crown Valley Pkwy, Suite G,
Laguna Niguel, CA 92677-1723

Ph: (949) 495-4245
Kelly Yeon Su Kim, DDS
30001 Crown Valley Pkwy, Suite G,
Laguna Niguel, CA 92677-1723

Ph: (949) 495-4245

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Dentist in Laguna Niguel, CA

Dr. Damian Newhart,
Dentist
Medicare: Not Enrolled in Medicare
Practice Location: 25500 Rancho Niguel Rd, Suite #210, Laguna Niguel, CA 92677
Phone: 949-215-0112    
Dr. Kenneth F Hinds, DDS
Dentist
Medicare: Not Enrolled in Medicare
Practice Location: 25500 Rancho Niguel Rd Ste 260, Laguna Niguel, CA 92677
Phone: 949-643-3129    Fax: 949-643-5259
Dr. Ronald Owen Davies, DDS
Dentist
Medicare: Not Enrolled in Medicare
Practice Location: 28241 Crown Valley Pkwy Pmb 620, Ste. F 620, Laguna Niguel, CA 92677
Phone: 949-362-9690    Fax: 949-448-8858
Dr. Negar Izadi, D.D.S
Dentist
Medicare: Not Enrolled in Medicare
Practice Location: 25026 Rancho Clemente, Laguna Niguel, CA 92677
Phone: 310-435-8961    
Dr. Sarah Kathryn Belderes, DDS
Dentist
Medicare: Medicare Enrolled
Practice Location: 25500 Rancho Niguel Rd, Ste 210, Laguna Niguel, CA 92677
Phone: 949-215-5500    
Maryam Haeri Maybodi, D.D.S
Dentist
Medicare: Not Enrolled in Medicare
Practice Location: 30101 Town Center Dr Ste 205, Laguna Niguel, CA 92677
Phone: 949-295-0940    

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