KELLY YEON SU KIM D.D.S
NPI 1053625715
Dentist - Pediatric Dentistry in Laguna Niguel, CA

Q: What is Kelly Kim's NPI number?

The NPI number for Kelly Kim is 1053625715. It was assigned to this individual provider in the NPPES registry on August 4, 2010.

Q: What is Kelly Kim's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Kim was last updated on June 16, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since August 04, 2010PECOS Enrolled

30001 CROWN VALLEY PKWY, SUITE G, LAGUNA NIGUEL, CA 92677(949) 495-4245 Get Directions Write a Review

NPPES record last updated: June 16, 2011. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Kelly Yeon Su Kim D.d.s NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY YEON SU KIM D.D.S (NPI 1053625715) is an individual pediatric dentistry provider in Laguna Niguel, California, licensed in California (58075) and active in the NPI registry since August 2010. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1053625715

Entity TypeIndividualFemale

Primary Taxonomy1223P0221X

Provider Legal NameKELLY YEON SU KIMCredential: D.D.S

Location Address30001 CROWN VALLEY PKWY, SUITE GLaguna Niguel, CA 92677-1723

Mailing Address30001 Crown Valley Pkwy, Suite GLaguna Niguel, CA 92677-1723 · (949) 495-4245

Phone(949) 495-4245

Sole ProprietorNo

Enumeration DateAugust 4, 2010

Last NPPES UpdateJune 16, 2011

✔ NPI 1053625715 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers

Taxonomy Code1223P0221X

Licenses✔ Licensed in CA · 58075✔ Licensed in NY · 055114

Definition

An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

30001 CROWN VALLEY PKWY, Laguna Niguel, CA 92677

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelly Yeon Su Kim D.d.s is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92677 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$96.36 typical visit price

range $62.96 – $187.60

Typical copayment $24.09 (range $15.74 – $46.90)

Most-billed visit code 99203

Established Patient

$77.96 typical visit price

range $20.84 – $153.61

Typical copayment $19.49 (range $5.21 – $38.40)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MILENA IMHOF PSYD

Psychologist (Clinical)

30001 CROWN VALLEY PKWY, SUITE P
LAGUNA NIGUEL, CA 92677

Orange County (310) 579-5254

JAMES M. KANE, O.D., A,P.C.

Optometrist

30001 CROWN VALLEY PKWY, SUITE F
LAGUNA NIGUEL, CA 92677

Orange County (949) 495-1610

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Kim's NPI number?

The NPI number for Kelly Kim is 1053625715. It was assigned to this individual provider in the NPPES registry on August 4, 2010.

Where is Kelly Kim located?

Kelly Kim practices at 30001 Crown Valley Pkwy Suite G, Laguna Niguel, CA 92677. The listed phone number is (949) 495-4245.

What is Kelly Kim's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Is Kelly Kim enrolled in Medicare?

Yes. Kelly Kim is registered in the Medicare PECOS enrollment system.

What insurance does Kelly Kim accept?

Health plans from Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Montana and Blue Cross and Blue Shield of Oklahoma and 6 other insurers list Kelly Kim as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kelly Kim was last updated on June 16, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.