Active NPI
Sung K Kim, D.D.S.
- Oral and Maxillofacial Radiology Dentistry
- Houston, TX
National Provider Identifier
1093042749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Radiology Dentistry
- License
- 36845
- Practice address
- 7500 Cambridge St # 5367
Houston, TX 77054-2032 - Phone
- (713) 486-4417
- NPI assigned
- Nov 17, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 10039 | CO | |
| Oral and Maxillofacial Radiology Dentistry | 1223X0008X | 36845 | TX | Primary |
Addresses
Primary practice location
7500 Cambridge St # 5367
Houston, TX 77054-2032
Mailing address
7500 Cambridge St # 5367
Houston, TX 77054-2032
Phone (713) 486-4417
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10039 | Other | CO | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10039 | CO | MD | Dentist |
| 36845 | TX | MD | Oral and Maxillofacial Radiology Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1258416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615420800000",
"number": "1093042749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7500 CAMBRIDGE ST # 5367",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770542032",
"telephone_number": "713-486-4417"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7500 CAMBRIDGE ST # 5367",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770542032",
"telephone_number": "713-486-4417"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SUNG",
"middle_name": "K",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-11-17",
"last_updated": "2021-03-11",
"certification_date": "2021-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "10039",
"primary": false
},
{
"code": "1223X0008X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Radiology",
"state": "TX",
"license": "36845",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "10039",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.