Dental Associates of Bryn Mawr

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DENTAL ASSOCIATES OF BRYN MAWR

Practice address

3224 W Bryn Mawr Ave
Chicago, IL 60659-3606

Phone

(773) 463-1212

NPI assigned

Nov 20, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Insun Kim, DDS

Title

Officer

Phone

(773) 463-1212

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073687265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3224 W BRYN MAWR AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606593606",
            "telephone_number": "773-463-1212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3224 W BRYN MAWR AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606593606",
            "telephone_number": "773-463-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL ASSOCIATES OF BRYN MAWR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "INSUN",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "773-463-1212",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.