Jonathan Kim, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DN122806 Issued in GA

Practice address

1830 Scenic Hwy N Ste 220
Snellville, GA 30078-2100

Phone

(770) 844-9454

NPI assigned

Sep 28, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1443398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664582400000",
    "number": "1083084404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4323 TACOMA TRCE",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300248731",
            "telephone_number": "678-361-6213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 SCENIC HWY N STE 220",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300782100",
            "telephone_number": "770-844-9454"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27289 Willow Leaf Rd",
            "address_purpose": "LOCATION",
            "city": "Moreno Valley",
            "state": "CA",
            "postal_code": "925554755",
            "country_code": "US",
            "telephone_number": "678-361-6213",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-09-28",
        "last_updated": "2022-10-01",
        "certification_date": "2022-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "65136",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "60793892",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN122806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sami Osman Khan, MD
• Kiara Kiah, RBT
• Deidre D. Kiefer, M.S./CCC/SLP/L
• Hye Jin Kim
• Jae Man Kim, PT
• Peter Kim
• Yong S Kim, M.D.
• Janelle Kimbrough, RBT
• Porsha Kimbrough, PMHNP
• Amy Duffy Kingry, CRNA

• Dentist in Snellville, GA
• Providers in Snellville, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2022; 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.