Active NPI
Syngbum Kim, D.D.S
- Dentist
- New York, NY
National Provider Identifier
1104965623
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 38514
- Practice address
- 10 E 40TH St
Suite 2105
New York, NY 10016-0200 - Phone
- (212) 779-3368
- Fax
- (212) 779-8254
- NPI assigned
- Feb 5, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 38514 | NY | Primary |
Addresses
Primary practice location
10 E 40TH St
Suite 2105
New York, NY 10016-0200
Mailing address
10 E 40TH St
Suite 2105
New York, NY 10016-0200
Phone (212) 779-3368
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 |
|---|---|---|---|
| 38514 | NY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bryant Park Dental Associate PLLC | Dentist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dentist
- New York, NY
- NPI 1083853063
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104965623",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 E 40TH ST",
"address_2": "SUITE 2105",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100160200",
"telephone_number": "212-779-3368"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 E 40TH ST",
"address_2": "SUITE 2105",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100160200",
"telephone_number": "212-779-3368",
"fax_number": "212-779-8254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SYNGBUM",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "38514",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
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.