Jae S. Kim, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401415308 Issued in VA

Practice address

1025 N Fillmore St
A
Arlington, VA 22201-6701

Phone

(703) 243-7744

NPI assigned

Jan 15, 2013

Last updated

Sep 26, 2016By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in OK

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

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.

• Virginia Center for Cosmetic and General Dentistry

  dba Virginia Dental Center

  • General Practice Dentistry
  • Arlington, VA
  • NPI 1649637828
  NPD (past)
• Virginia Dental Center

  • Dentist
  • Arlington, VA
  • NPI 1568997872
  NPD (past)

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

{
    "created_epoch": "1358208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474848000000",
    "number": "1215274865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 N FILLMORE ST",
            "address_2": "A",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222016701",
            "telephone_number": "703-243-7744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 N FILLMORE ST",
            "address_2": "A",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222016701",
            "telephone_number": "703-243-7744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JAE",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-01-15",
        "last_updated": "2016-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "61791",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401415308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dahea Kim
• Duke H Kim, DDS MAGD
• Elizabeth Sangah Kim, M.D.
• Eric Jeonghyun Kim
• Eunae Kim
• Jae Y Kim, M.D.
• Michelle Kim, M. CL. SC.
• Nancy Carol Kim, MD
• Rebecca Anne Wyckoff Kim, PHD
• Shawn J Kim, DMD

• General Practice Dentistry in Arlington, VA
• Providers in Arlington, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2016; 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.