John W Kim, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN122546 Issued in GA

Practice address

1135 Highway 85 N Ste a
Fayetteville, GA 30214-2085

Phone

(407) 587-9665

NPI assigned

Jul 2, 2012

Sex

Male

Sole proprietor

No

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

Enrolled in FL

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 and National Provider Directory roles.

• Angel F. Lopez D.M.D., P.a.

  • General Practice Dentistry
  • Oviedo, FL
  • NPI 1750585188
  NPD (past)

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

{
    "created_epoch": "1341187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640736000000",
    "number": "1083978266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1135 HIGHWAY 85 N STE A",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302142085",
            "telephone_number": "407-587-9665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 HIGHWAY 85 N STE A",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302142085",
            "telephone_number": "407-587-9665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JOHN",
        "middle_name": "W",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-02",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN19740",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN19740",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN122546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kids Medical Therapies Inc.
• Kids Time Pediatrics of Southern Crescent, LLC
• Brett Joseph Kieffer, AA-S
• Thomas Matthew Kilgore, DPT
• Elizabeth W Killebrew, MD
• Rasheeda Kimbro
• Kindness and Kompassion in-Home Care
• Alaija King, RBT
• Dale L King, LCSW
• Jasmane King, RBT

• General Practice Dentistry in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2021; 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.