Jung H Kim, DDS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

056054 Issued in NY

Practice address

309A Broad Ave
Palisades Park, NJ 07650-1620

Phone

(201) 242-9300

NPI assigned

Jun 15, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Palisades Park Bo Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Palisades Park, NJ
  • NPI 1275912248
  NPD (past)

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

{
    "created_epoch": "1308096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352937600000",
    "number": "1174818496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2175 HUDSON TER APT 7I",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070247715",
            "telephone_number": "201-676-0029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309A BROAD AVE",
            "city": "PALISADES PARK",
            "state": "NJ",
            "postal_code": "076501620",
            "telephone_number": "201-242-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JUNG",
        "middle_name": "H",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-15",
        "last_updated": "2012-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NY",
            "license": "056054",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NJ",
            "license": "22DI02504500",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY STATE TEACHING PERMIT NO",
            "identifier": "P77908",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "034481918",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ji Myung Kim
• Jinna Kim, OD
• John J Kim, O.D.
• Jonathan Jaeyoung Kim, D.C.
• Julia E. Kim, O.D.
• Justin Kim, MDPP COACH
• Martin Sung Kim, OD
• Sean Kim, DC
• Seung Hee Kim
• Steven Kim, DMD

• Orthodontics and Dentofacial Orthopedics Dentistry in Palisades Park, NJ
• Providers in Palisades Park, NJ by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; 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.