Active NPI
Soung Cheoul Kim, DMD
- Dentist
- Boston, MA
National Provider Identifier
1063969525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN1857411
- Practice address
- 99 Kneeled Street Apt 713
Boston, MA 02111 - Phone
- (929) 264-6303
- NPI assigned
- Sep 1, 2016
- Last updated
- Sep 1, 2016
- Sex
- Male
- Sole proprietor
- Yes
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 | DN1857411 | MA | Primary |
Addresses
Primary practice location
99 Kneeled Street Apt 713
Boston, MA 02111
Mailing address
99 Kneeland St Apt 713
Boston, MA 02111-2438
Phone (929) 264-6303
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 |
|---|---|---|---|
| DN1857411 | MA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472688000000",
"number": "1063969525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "99 KNEELAND ST APT 713",
"city": "BOSTON",
"state": "MA",
"postal_code": "021112438",
"telephone_number": "929-264-6303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "99 KNEELED STREET APT 713",
"city": "BOSTON",
"state": "MA",
"postal_code": "02111",
"telephone_number": "929-264-6303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SOUNG",
"middle_name": "CHEOUL",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-09-01",
"last_updated": "2016-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DN1857411",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.