Active NPI
Sumin Kim
- General Practice Dentistry
- Cicero, IL
National Provider Identifier
1124720859
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019.034426
- Practice address
- 2254 S Cicero Ave
Cicero, IL 60804-2411 - Phone
- (708) 656-2222
- NPI assigned
- Mar 20, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| General Practice Dentistry | 1223G0001X | 019.034426 | IL | Primary |
Addresses
Primary practice location
2254 S Cicero Ave
Cicero, IL 60804-2411
Mailing address
247 E 28TH St Apt 17F
New York, NY 10016-7238
Phone (217) 417-2922
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 |
|---|---|---|---|
| 019.034426 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689120000000",
"number": "1124720859",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "247 E 28TH ST APT 17F",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100167238",
"telephone_number": "217-417-2922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2254 S CICERO AVE",
"city": "CICERO",
"state": "IL",
"postal_code": "608042411",
"telephone_number": "708-656-2222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SUMIN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-20",
"last_updated": "2023-07-12",
"certification_date": "2023-07-12",
"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": "IL",
"license": "019.034426",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cicero, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.