Peter H Kim, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DE00008656 Issued in WA

Practice address

16410 Smokey Point Blvd
Suite 103
Arlington, WA 98223-8415

Phone

(360) 651-1359

Fax

(360) 659-1275

NPI assigned

Feb 15, 2007

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective May 9, 2012 through May 9, 2028

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.

• Kincaid, McClary & Kim D.D.S, P.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Arlington, WA
  • NPI 1043267925
  NPD (past)

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1093858318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16410 SMOKEY POINT BLVD",
            "address_2": "SUITE 103",
            "city": "ARLINGTON",
            "state": "WA",
            "postal_code": "982238415",
            "telephone_number": "360-651-1359",
            "fax_number": "360-659-1275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16410 SMOKEY POINT BLVD",
            "address_2": "SUITE 103",
            "city": "ARLINGTON",
            "state": "WA",
            "postal_code": "982238415",
            "telephone_number": "360-651-1359",
            "fax_number": "360-659-1275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "PETER",
        "middle_name": "H",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE00008656",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "GA10000282",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "141618",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5034640",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kim and Lee, DMDS, PLLC (Boulevard Dental Arlington)
• Donghyun Kim, DMD
• Edward Kim
• Hannah Linda Kim, M.D.
• Jena Kim
• Tiffanie P.O. Kimura, RDH
• Kincaid, McClary & Kim D.D.S, P.S.
• Elizabeth Samantha King
• Jeremy R King, MSN, ARNP, FNP-C
• KLN Counseling PLLC

• Oral and Maxillofacial Surgery (Dentist) in Arlington, WA
• Providers in Arlington, WA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.