Soomin Richard Kim, DDS, MPH

Primary specialty

DentistTaxonomy code 122300000X

License

23450 Issued in TX

Practice address

6423 Escena Blvd Unit 1070
Irving, TX 75039-4268

Phone

(213) 999-7177

NPI assigned

Jul 20, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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

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

{
    "created_epoch": "1184889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346025600000",
    "number": "1083814784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6423 ESCENA BLVD #1070",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750393159",
            "telephone_number": "213-999-7177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6423 ESCENA BLVD UNIT 1070",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750394268",
            "telephone_number": "213-999-7177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SOOMIN",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "DDS, MPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-20",
        "last_updated": "2012-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "23450",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "56019",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Kim, PA-C
• Moonhwan Kim
• Ryan Sangwoo Kim, MD
• Sarah Chong Kim, PA-C
• Sharon Kim
• Yong Kyu Kim
• Kimberly Chesshir MD, P.a.
• Wendi Layne Kimbrell, FNP-C
• Donna Kimbrough, MA,LPC,BCBA
• Brianna King

• Dentist in Irving, TX
• Providers in Irving, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2012; 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.