Michael Duckhyun Kim, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

42739 Issued in CA

Practice address

1092 E Green St
Pasadena, CA 91106-2506

Phone

(626) 795-9328

Fax

(626) 795-3763

NPI assigned

Sep 3, 2009

Last updated

Sep 3, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• David R. Wyndhamsmith, a Professional Dental Corporation

  dba Pasadena Medical/Dental Specialist

  • Endodontics
  • Pasadena, CA
  • NPI 1508088675
  NPD (past)
• David R. Wyndhamsmith, a Professional Dental Corporation

  • General Practice Dentistry
  • Pasadena, CA
  • NPI 1881816957
  NPD (past)

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

{
    "created_epoch": "1251936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251936000000",
    "number": "1073746228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1092 E GREEN ST",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911062506",
            "telephone_number": "626-795-9328",
            "fax_number": "626-795-3763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1092 E GREEN ST",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911062506",
            "telephone_number": "626-795-9328",
            "fax_number": "626-795-3763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MICHAEL",
        "middle_name": "DUCKHYUN",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-09-03",
        "last_updated": "2009-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "42739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda S Kim
• Lisa Jayi Kim, PHARMD
• Mark Joong-Pyoung Kim, DPT
• Matthew Kim, DO
• Mi Ae Kim, LMFT
• Michelle Kim, PHARMD
• Michelle Heejung Kim, LMFT
• Michelle Kyongah Kim, DDS
• Mili Kim
• Min Joo Kim, BCBA

• General Practice Dentistry in Pasadena, CA
• Providers in Pasadena, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2009; 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.