Ji Won Kim

Primary specialty

DentistTaxonomy code 122300000X

License

DN1859098 Issued in MA

Practice address

555 State St
Springfield, MA 01109-4140

Phone

(312) 768-0965

NPI assigned

Apr 27, 2021

Last updated

Jul 21, 2021By the provider in NPPES

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1619481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626825600000",
    "number": "1164004206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 N CLARK ST STE 600",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606544782",
            "telephone_number": "312-274-4580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 STATE ST",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011094140",
            "telephone_number": "312-768-0965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JI WON",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-27",
        "last_updated": "2021-07-21",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1859098",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• PJ Kilfeather
• Justine Gene Kilian
• Jennifer T Killips, NP
• Allison Kilty
• Andrew I Kim, MD
• Ji Yoon Kim, PHARMD
• Paul Kim, MD
• Tommy Kim, MD
• Young Hee Kim, MS, RD, CNSD
• Young K Kim, PHD

• Dentist in Springfield, MA
• Providers in Springfield, MA by specialty
• Dentist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.