Active NPI
Taekeong Kim
- Orthodontics and Dentofacial Orthopedics Dentistry
- Fort Worth, TX
National Provider Identifier
1164168092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 38362
- Practice address
- 3411 Sycamore School Rd
Fort Worth, TX 76123-2091 - Phone
- (682) 233-9326
- NPI assigned
- May 12, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 38362 | TX | Primary |
Addresses
Primary practice location
3411 Sycamore School Rd
Fort Worth, TX 76123-2091
Mailing address
5270 N O Connor Blvd Apt 1524
Irving, TX 75039-5725
Phone (415) 996-4082
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 |
|---|---|---|---|
| 38362 | TX | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652313600000",
"number": "1164168092",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5270 N O CONNOR BLVD APT 1524",
"city": "IRVING",
"state": "TX",
"postal_code": "750395725",
"telephone_number": "415-996-4082"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3411 SYCAMORE SCHOOL RD",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761232091",
"telephone_number": "682-233-9326"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "TAEKEONG",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-05-12",
"last_updated": "2022-05-12",
"certification_date": "2022-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "TX",
"license": "38362",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.