Shin Joseph Kim, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DN28761 Issued in FL

Practice address

13128 14TH Street
Camp Pendleton, CA 92058

Phone

(760) 763-1126

NPI assigned

Mar 26, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Sage Dental of Conway PLLC

  • Dentist
  • Belle Isle, FL
  • NPI 1295110302
  NPD (past)

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

{
    "created_epoch": "1269561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705622400000",
    "number": "1154645661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1234 BELLINGHAM DR",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920572723",
            "telephone_number": "818-523-7253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13128 14TH STREET",
            "city": "CAMP PENDLETON",
            "state": "CA",
            "postal_code": "92058",
            "telephone_number": "760-763-1126"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4441 Hoffner Ave",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328122331",
            "country_code": "US",
            "telephone_number": "407-218-4744",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "SHIN",
        "middle_name": "JOSEPH",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-26",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "7764010-9921-2014040",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "DDS107230",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN28761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ruslei Marie Khoury, FNP
• Cassandra Elise Kijek, MD
• Audrey Borahm Kim, DDS
• Cecilia Kim, DO
• Daniel E Kim
• Thomas Kiner, M.D.
• William King-Lewis, M.D.
• Kiley Caroline Brady Kirby, MD
• Richard Alexander Knab, DO
• Cari Jo Knudson, RD

• Oral and Maxillofacial Surgery (Dentist) in Camp Pendleton, CA
• Providers in Camp Pendleton, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; 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.