GRACE KIM
NPI 1538052196
Dentist - General Practice in San Pedro, CA

Q: What is Grace Kim's NPI number?

The NPI number for Grace Kim is 1538052196. It was assigned to this individual provider in the NPPES registry on June 2, 2025.

Q: What is Grace Kim's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: When was this NPI record last updated?

The NPPES record for Grace Kim was last updated on June 2, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months 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 June 02, 2025PECOS Enrolled

425 S PACIFIC AVE, SAN PEDRO, CA 90731(310) 547-0202 Get Directions Write a Review

NPPES record last updated: June 2, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Grace Kim NPPES

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

GRACE KIM (NPI 1538052196) is an individual general practice provider in San Pedro, California, licensed in California (111597) and active in the NPI registry since June 2025. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1538052196

Entity TypeIndividualFemale

Primary Taxonomy1223G0001X

Provider Legal NameGRACE KIM

Location Address425 S PACIFIC AVESan Pedro, CA 90731-2625

Mailing Address205d Evans St Apt 4Buffalo, NY 14221-5618

Phone(310) 547-0202

Sole ProprietorNo

Enumeration DateJune 2, 2025

NPPES CertifiedMay 12, 2025

✔ NPI 1538052196 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in CA · 111597

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

425 S PACIFIC AVE, San Pedro, CA 90731

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Humana.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)

Grace Kim 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 90731 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 5

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

DR. MAILE STEPHANIE OSBORNE DDS

Dentist (General Practice)