Kibeom Seo, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12938 Issued in CT

Practice address

105 Myrtle St
New Britain, CT 06051-1859

Phone

(860) 801-8650

NPI assigned

Nov 24, 2020

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

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• Staywell Health Care, Inc.

  • Family Medicine Physician
  • Waterbury, CT
  • NPI 1154342335
  Medicare reassignment NPD
• Columbia Implant Center LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Manchester, CT
  • NPI 1093502312
  NPD (past)
• Wolcott Street Dental-1, PC

  dba Sutton Dental

  • Dentist
  • New Britain, CT
  • NPI 1013158484
  NPD (past)

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

{
    "created_epoch": "1606176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730419200000",
    "number": "1205430816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4234 TOWN BROOKE",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064576612",
            "telephone_number": "716-352-8080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 MYRTLE ST",
            "city": "NEW BRITAIN",
            "state": "CT",
            "postal_code": "060511859",
            "telephone_number": "860-801-8650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEO",
        "first_name": "KIBEOM",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-24",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "12938",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "12938",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Richard Secor Jr., N.D.,M.S.,L.AC.
• Lynsey Seelye
• Patricia Segal
• Harikleia Evangelia Seiderer, LMFT
• Bethany Selling
• Neil N Seong, MD
• Luis A Serazo, PA-C
• Martin C Seremet, M.D.
• Elizabeth Sesto, LPC
• Ijaz Shafi, MD

• General Practice Dentistry in New Britain, CT
• Providers in New Britain, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2024; 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.

Verify at the official NPI Registry.