Active NPI
Sharon Kim
- General Practice Dentistry
- Lacey, WA
National Provider Identifier
1174202915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DE61456935
- Practice address
- 5122 Yelm Hwy SE
Lacey, WA 98503-5034 - Phone
- (360) 528-7878
- NPI assigned
- Jul 17, 2023
- Sex
- Female
- 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 | DE61456935 | WA | Primary |
Addresses
Primary practice location
5122 Yelm Hwy SE
Lacey, WA 98503-5034
Mailing address
5122 Yelm Hwy SE
Lacey, WA 98503-5034
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231024001571 | WA | Order and Referring Only - Dentist | 6800242066 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689552000000",
"number": "1174202915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5122 YELM HWY SE",
"city": "LACEY",
"state": "WA",
"postal_code": "985035034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5122 YELM HWY SE",
"city": "LACEY",
"state": "WA",
"postal_code": "985035034",
"telephone_number": "360-528-7878"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SHARON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-17",
"last_updated": "2023-07-17",
"certification_date": "2023-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "DE61456935",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lacey, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; 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.