Active NPI
Seok-Jin Kim, DDS, MSD
- Periodontics
- Indianapolis, IN
National Provider Identifier
1104949783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 12010267A
- Practice address
- 1121 W Michigan St
Indianapolis, IN 46202-5211 - Phone
- (317) 274-5421
- NPI assigned
- Apr 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 12010267A | IN | Primary |
Addresses
Primary practice location
1121 W Michigan St
Indianapolis, IN 46202-5211
Mailing address
1121 W Michigan St
Indianapolis, IN 46202-5211
Phone (317) 274-5421
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 |
|---|---|---|---|
| 12010267A | IN | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104949783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1121 W MICHIGAN ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462025211",
"telephone_number": "317-274-5421"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1121 W MICHIGAN ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462025211",
"telephone_number": "317-274-5421"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SEOK-JIN",
"name_prefix": "Dr.",
"credential": "DDS, MSD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "IN",
"license": "12010267A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.