Charles Junghyun Kim, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE8256 Issued in WA

Practice address

10217 19TH Ave SE Ste 202
Everett, WA 98208-4266

Phone

(425) 220-7512

NPI assigned

Aug 1, 2006

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 identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Networks

• WA PPO C-SNP

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.

• Kim & Kim, DDS, PS

  • General Practice Dentistry
  • Everett, WA
  • NPI 1407060478
  NPD (past) Authorized official

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1063429447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10217 19TH AVE SE STE 202",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982084266",
            "telephone_number": "425-220-7512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10217 19TH AVE SE STE 202",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982084266",
            "telephone_number": "425-220-7512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "CHARLES",
        "middle_name": "JUNGHYUN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE8256",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5041512",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kim Alan McGinnis DDS
• Kim Trieu, DDS, PLLC
• Alice Kim, PHARMD
• Bryan Kim, MD
• Caleb Youngho Kim
• Dae Ho Kim, DDS
• Daniel Byeongheui Kim, MD
• Darran Kim, OD
• David Eugene Kim, DPT
• Duk Soo Kim, DO

• General Practice Dentistry in Everett, WA
• Providers in Everett, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.