Hae Jin Kim, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

16645 Issued in MD

Practice address

11325 Seven Locks Rd Ste 250
Potomac, MD 20854-3269

Phone

(240) 642-3161

Fax

(240) 642-3162

NPI assigned

Jul 25, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Moco Pediatric Dentistry LLC

  dba Plover Pediatric Dentistry

  • Pediatric Dentistry
  • Potomac, MD
  • NPI 1811571318
  NPD Authorized official
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1311552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1104104132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11325 SEVEN LOCKS RD STE 250",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "208543269",
            "telephone_number": "240-642-3161",
            "fax_number": "240-642-3162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11325 SEVEN LOCKS RD STE 250",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "208543269",
            "telephone_number": "240-642-3161",
            "fax_number": "240-642-3162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "HAE JIN",
        "name_prefix": "Ms.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-25",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MD",
            "license": "16645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kasra Khamooshi
• Irfan Ahmad Khan, PHARM.D.
• Savan Nand Khanna, PHARMD
• Hanieh Khorshidi, BSN, AGNP-BC
• Kid's Neuro
• Sara C Kim
• Kinetic Cardiology Services
• Kinetic Medical Group
• Kinetic Palliative Group
• Kinetic Primary Care

• Pediatric Dentistry in Potomac, MD
• Providers in Potomac, MD by specialty
• Pediatric Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.

Verify at the official NPI Registry.