Richard Hyungsang Kim, D.D.S., M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D11363 Issued in MN

Practice address

1990 Premiere Dr
Mankato, MN 56001-5900

Phone

(507) 625-9330

Fax

(507) 625-1440

NPI assigned

Dec 13, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Associates in Oral and Maxillofacial Surgery, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Mankato, MN
  • NPI 1578596177

  Oral and Maxillofacial Surgery

  NPD (past)
• Southeastern Minnesota Oral & Maxillofacial Surgery Associates

  • Oral and Maxillofacial Surgery Clinic/Center
  • Rochester, MN
  • NPI 1659492312
  NPD (past)
• All Kids Dental Center, LLC

  • General Practice Dentistry
  • Melrose Park, IL
  • NPI 1003246927

  Oral and Maxillofacial Surgery

  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 2, 2015 through Jul 2, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003977653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1990 PREMIERE DR",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015900",
            "telephone_number": "507-625-9330",
            "fax_number": "507-625-1440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1990 PREMIERE DR",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015900",
            "telephone_number": "507-625-9330",
            "fax_number": "507-625-1440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "RICHARD",
        "middle_name": "HYUNGSANG",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "D11363",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "100680",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "355K4KI",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sandeep Singh Khosa, MD
• Grace Nimat Khouri, MD
• Kelsey Ann Kidd
• Hailey June Kiewiet
• Myung Jin Kim, PT
• Chloe Kindgren
• Kindred Connections Speech & Language Therapy LLC
• Lisa Kindred, M.S., CCC-SLP
• Kinetic Chiropractic, P.C.
• Alexia King

• All providers in Mankato, MN
• Oral and Maxillofacial Surgery (Dentist) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.