Michael Jong-Gyu Kim, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

101618 Issued in CA

Practice address

27382 Calle Arroyo
San Juan Capistrano, CA 92675-2746

Phone

(949) 218-6888

NPI assigned

Jan 9, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1389225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542585600000",
    "number": "1174945273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27382 CALLE ARROYO",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926752746",
            "telephone_number": "949-218-6888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27382 CALLE ARROYO",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926752746",
            "telephone_number": "949-218-6888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MICHAEL",
        "middle_name": "JONG-GYU",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-01-09",
        "last_updated": "2018-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "101618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clayton Eugene Kibler, MD, MMS
• Joseph Keith Kikumoto, O.D.
• Dan Hakjae Kim, D.C.
• Deisy Kim, MA
• Katharine Sujin Kim
• Bryan O King, M.D.
• Olutosin Kirya, DTR, CLT
• Tyler Kist, PT, DPT
• Barbara Lee Klein-Robuck, MS, RN
• Brian Klein

• General Practice Dentistry in San Juan Capistrano, CA
• Providers in San Juan Capistrano, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2018; 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.