Active NPI
Tae Yung Kim, DMD
- General Practice Dentistry
- Jacksonville, FL
National Provider Identifier
1154842797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DS041435
- Practice address
- BLDG H 2005 Knight Lane
Navy Medicine Support Command Attn: Medical Staff SVCS
Jacksonville, FL 32212 - Phone
- (760) 725-0140
- NPI assigned
- Jul 5, 2017
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DS041435 | PA | Primary |
Addresses
Primary practice location
BLDG H 2005 Knight Lane
Navy Medicine Support Command Attn: Medical Staff SVCS
Jacksonville, FL 32212
Mailing address
505 West Bobier Drive
Apt 302
Vista, CA 92083
Phone (215) 962-6316
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 |
|---|---|---|---|
| DS041435 | PA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1499212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1499212800000",
"number": "1154842797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 WEST BOBIER DRIVE",
"address_2": "APT 302",
"city": "VISTA",
"state": "CA",
"postal_code": "92083",
"telephone_number": "215-962-6316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "BLDG H 2005 KNIGHT LANE",
"address_2": "NAVY MEDICINE SUPPORT COMMAND ATTN: MEDICAL STAFF SVCS",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32212",
"telephone_number": "760-725-0140"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "TAE",
"middle_name": "YUNG",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-07-05",
"last_updated": "2017-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "PA",
"license": "DS041435",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.