Paul Sung Jun Kim, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

110095 Issued in CA

Practice address

972 Goodrich Blvd
Commerce, CA 90022-4114

Phone

(818) 306-7150

NPI assigned

Mar 31, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

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.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Metro Community Provider Network Inc

  • Federally Qualified Health Center (FQHC)
  • Aurora, CO
  • NPI 1558727883
  Medicare reassignment NPD
• Metro Community Provider Network Inc

  • Federally Qualified Health Center (FQHC)
  • Parker, CO
  • NPI 1396188801
  NPD
• Metro Community Provider Network, Inc.

  • Community/Retail Pharmacy
  • Aurora, CO
  • NPI 1255591780
  NPD

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

{
    "created_epoch": "1617148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743465600000",
    "number": "1114505138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "972 GOODRICH BLVD",
            "city": "COMMERCE",
            "state": "CA",
            "postal_code": "900224114",
            "telephone_number": "818-306-7150",
            "fax_number": "303-343-0247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "972 GOODRICH BLVD",
            "city": "COMMERCE",
            "state": "CA",
            "postal_code": "900224114",
            "telephone_number": "818-306-7150"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3292 Peoria St",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800101517",
            "country_code": "US",
            "telephone_number": "303-360-6276",
            "fax_number": "303-789-7222",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "301 W 6th Ave",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802045182",
            "country_code": "US",
            "telephone_number": "303-436-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3494 Eagle Blvd",
            "address_purpose": "LOCATION",
            "city": "Brighton",
            "state": "CO",
            "postal_code": "806017403",
            "country_code": "US",
            "telephone_number": "818-306-7150",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17866 Cottonwood Dr",
            "address_purpose": "LOCATION",
            "city": "Parker",
            "state": "CO",
            "postal_code": "801343924",
            "country_code": "US",
            "telephone_number": "303-360-6276",
            "fax_number": "303-789-7222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "PAUL",
        "middle_name": "SUNG JUN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-31",
        "last_updated": "2025-04-01",
        "certification_date": "2025-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "110095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tamara Kennick
• Michael Kent
• Chaney Keo
• Alfredo Kertzman
• Susan Lacole Killian
• Sunghye Kim, MD
• Dana Michelle Zienert Kind
• Florian King
• Reynisha King
• Kingsbridge Hospice, Inc

• General Practice Dentistry in Commerce, CA
• Providers in Commerce, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.