Ji In Kim, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

6120 Issued in NV

Practice address

150 E Centennial Pkwy Ste 113
N Las Vegas, NV 89084

Phone

(702) 642-1386

Fax

(702) 642-6321

NPI assigned

Nov 24, 2008

Last updated

Apr 24, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ji in Kim, D.D.S., Professional Corporation

  dba Dynamic Dental

  • General Practice Dentistry
  • North Las Vegas, NV
  • NPI 1881439016
  NPD Authorized official

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

{
    "created_epoch": "1227484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556064000000",
    "number": "1164677746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 E CENTENNIAL PKWY STE 113",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890841338",
            "telephone_number": "702-642-1386",
            "fax_number": "702-642-6321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 E CENTENNIAL PKWY STE 113",
            "city": "N LAS VEGAS",
            "state": "NV",
            "postal_code": "89084",
            "telephone_number": "702-642-1386",
            "fax_number": "702-642-6321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 E Centennial Pkwy Ste 113",
            "address_purpose": "LOCATION",
            "city": "N Las Vegas",
            "state": "NV",
            "postal_code": "89084",
            "country_code": "US",
            "telephone_number": "702-642-1386",
            "fax_number": "702-642-6321",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "JI",
        "middle_name": "IN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-24",
        "last_updated": "2019-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "57816",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NV",
            "license": "6120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madeline Kelley
• Rhonda Denise Kelly
• Doris Ann Kennedy, M.ED
• Khoa D Le
• Kietre Medical and Behavioral Clinic
• Lance J Kim, DMD
• Adrian King
• Amy L. J. King, NP
• Lachesity Maria King
• Andrea L Kinsey

• Dentist in N Las Vegas, NV
• Providers in N Las Vegas, NV by specialty
• Dentist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2019; 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.