Active NPI
Kijung Kim
- Pediatric Dentistry
- Seekonk, MA
National Provider Identifier
1124316252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DN1857913
- Practice address
- 1201 Fall River Ave
Seekonk, MA 02771-5929 - Phone
- (508) 948-0872
- NPI assigned
- Jul 11, 2011
- Last updated
- Sep 13, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DN1857913 | MA | Primary |
Addresses
Primary practice location
1201 Fall River Ave
Seekonk, MA 02771-5929
Mailing address
1201 Fall River Ave
Seekonk, MA 02771-5929
Phone (550) 894-8087
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1857913 | MA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694563200000",
"number": "1124316252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 FALL RIVER AVE",
"city": "SEEKONK",
"state": "MA",
"postal_code": "027715929",
"telephone_number": "550-894-8087"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 FALL RIVER AVE",
"city": "SEEKONK",
"state": "MA",
"postal_code": "027715929",
"telephone_number": "508-948-0872"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "KIJUNG",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-07-11",
"last_updated": "2023-09-13",
"certification_date": "2023-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "MA",
"license": "DN1857913",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seekonk, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.