Jayun Joanna Kim, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

38358 Issued in TX

Practice address

4920 TX-121 #200
Lewisville, TX 75056

Phone

(972) 300-4155

NPI assigned

Nov 14, 2017

Last updated

Sep 28, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• S&J Dentistry

  • General Practice Dentistry
  • Allen, TX
  • NPI 1487433165
  Authorized official Same address or phone
• Greenwell Family Dentistry, PSC

  dba Generations Family Dentistry

  • General Practice Dentistry
  • Louisville, KY
  • NPI 1205070034
  NPD (past)

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

{
    "created_epoch": "1510617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1194238956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "663 TRAIL SIDE DR",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750677884",
            "telephone_number": "502-753-9941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4920 TX-121 #200",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "75056",
            "telephone_number": "972-300-4155"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "254 Market Place Dr",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402295450",
            "country_code": "US",
            "telephone_number": "502-955-6134",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1211 W Broadway",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402032082",
            "country_code": "US",
            "telephone_number": "502-874-5178",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "JAYUN",
        "middle_name": "JOANNA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-14",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "10038",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "10038",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "38358",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100499030",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Berningeh F Kigham, PHARM D
• Joseph Richard Kilianski III, M.D.
• Bumm Kim, DC
• Christa Yong Eun Kim, OD
• Eun Myung Kim, MS, RDN, LD
• Damonica Neshelle Kincaid, LVN
• Kind Acts LLC
• Keyunna M King
• Kingdom Life Chiropractic LLC
• Melissa Hester Kinney, M.D.

• Dentist in Lewisville, TX
• Providers in Lewisville, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 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.

Verify at the official NPI Registry.