Active NPI
Jonathan Juyun Kim, DDS
- General Practice Dentistry
- Beaverton, OR
National Provider Identifier
1013568294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D11080
- Practice address
- 4925 SW Griffith Dr
Beaverton, OR 97005-2923 - Phone
- (855) 433-6825
- NPI assigned
- Sep 27, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D11080 | OR | Primary |
Addresses
Primary practice location
4925 SW Griffith Dr
Beaverton, OR 97005-2923
Mailing address
6950 NE Campus Way
Hillsboro, OR 97124-5611
Phone (855) 433-6285
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200720000255 | OR | Order and Referring Only - Dentist | 7315361755 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D11080 | OR | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593993600000",
"number": "1013568294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6950 NE CAMPUS WAY",
"city": "HILLSBORO",
"state": "OR",
"postal_code": "971245611",
"telephone_number": "855-433-6285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4925 SW GRIFFITH DR",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970052923",
"telephone_number": "855-433-6825"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JONATHAN",
"middle_name": "JUYUN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-27",
"last_updated": "2020-07-06",
"certification_date": "2020-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OR",
"license": "D11080",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2020; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.