Seongryeol Albert Kim, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

019028319 Issued in IL

Practice address

3505 NW Anderson Hill Rd
Silverdale, WA 98383-9161

Phone

(360) 337-1780

Fax

(309) 243-8188

NPI assigned

Dec 29, 2006

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

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277251200000",
    "number": "1154487445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11825 N KNOXVILLE AVE",
            "city": "DUNLAP",
            "state": "IL",
            "postal_code": "61525",
            "telephone_number": "309-243-1541",
            "fax_number": "309-243-8188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 NW ANDERSON HILL RD",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983839161",
            "telephone_number": "360-337-1780",
            "fax_number": "309-243-8188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SEONGRYEOL",
        "middle_name": "ALBERT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2010-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00010423",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019028319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacee M Kessinger, M.D.
• David Joseph Kessler, M.D.
• Betsy Kidd, PHARMD
• Lauren Kilburn, PA-C
• David Keesu Kim, M.D.
• Carissa King
• Dale Michael King, D.D.S.
• Dore Ann King, LMP
• Harley Wren Kinyon, CCC-A
• Vika Elloise Kirk

• Dentist in Silverdale, WA
• Providers in Silverdale, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2010; 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.