Active NPI
Misook Kim, DMD
- Dentist
- Salem, OR
National Provider Identifier
1063444040
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D6841
- Practice address
- 3750 Chemawa Rd NE
Chemawa Indian Health Center
Salem, OR 97305-1111 - Phone
- (503) 304-7600
- Fax
- (503) 304-7677
- NPI assigned
- Jul 7, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | D6841 | OR | Primary |
Addresses
Primary practice location
3750 Chemawa Rd NE
Chemawa Indian Health Center
Salem, OR 97305-1111
Mailing address
3750 Chemawa Rd NE
Salem, OR 97305-1111
Phone (503) 304-7631
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 278159 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D6841 | OR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063444040",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3750 CHEMAWA RD NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973051111",
"telephone_number": "503-304-7631",
"fax_number": "503-304-7677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3750 CHEMAWA RD NE",
"address_2": "CHEMAWA INDIAN HEALTH CENTER",
"city": "SALEM",
"state": "OR",
"postal_code": "973051111",
"telephone_number": "503-304-7600",
"fax_number": "503-304-7677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MISOOK",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D6841",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "278159",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.