Jake Kim, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

39478 Issued in TX

Practice address

507 Jefferson LN
Lake Dallas, TX 75065-3489

Phone

(703) 477-4659

NPI assigned

Jun 28, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Jake Kim Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• 1010 Dental PLLC

  • Dentist
  • Allen, TX
  • NPI 1972441327
  NPD Authorized official
• 1010 Emergency Dental PLLC

  • Dental Clinic/Center
  • Lake Dallas, TX
  • NPI 1730915802
  NPD Authorized official

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

{
    "created_epoch": "1624838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732406400000",
    "number": "1053981407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 JEFFERSON LN",
            "city": "LAKE DALLAS",
            "state": "TX",
            "postal_code": "750653489",
            "telephone_number": "703-477-4659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 JEFFERSON LN",
            "city": "LAKE DALLAS",
            "state": "TX",
            "postal_code": "750653489",
            "telephone_number": "703-477-4659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JAKE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-28",
        "last_updated": "2024-11-24",
        "certification_date": "2024-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "39478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAKE",
            "last_name": "KIM",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Madeline Nicole Hayes Berkhout, SLP-A
• Bridget Jaecks, MS, LPC, LCDC
• Cynthia Johnson Jones, LPC-S
• K2 Home Healthcare, Inc.
• Bonnie Kiefel, LCDC
• Kathy L. King, R.D.N.
• Jerome P. Kralka I
• Lake Dallas Family Medicine PLLC
• Lake Dallas Isd
• Suzy Messinger, PTA

• General Practice Dentistry in Lake Dallas, TX
• Providers in Lake Dallas, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.