Tony Jaewon Kim, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

42246 Issued in TX

Practice address

10175 Gateway Blvd W Ste 304
El Paso, TX 79925-2203

Phone

(915) 504-6880

NPI assigned

May 19, 2020

Sex

Male

Sole proprietor

No

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)

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.

• West Texas Maxillofacial Surgery PA

  • Oral & Maxillofacial Surgery (D.M.D.)
  • El Paso, TX
  • NPI 1700178555
  NPD (past)

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

{
    "created_epoch": "1589846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787616000000",
    "number": "1245853753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10175 GATEWAY BLVD W STE 304",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799252203",
            "telephone_number": "915-504-6880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10175 GATEWAY BLVD W STE 304",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799252203",
            "telephone_number": "915-504-6880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1770 Cimarron Rialto Pl",
            "address_purpose": "LOCATION",
            "city": "El Paso",
            "state": "TX",
            "postal_code": "799112200",
            "country_code": "US",
            "telephone_number": "915-504-6880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "TONY",
        "middle_name": "JAEWON",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-19",
        "last_updated": "2026-08-25",
        "certification_date": "2026-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "42246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Noah Kim, D.O.
• Peter Eusuk Kim, DMD
• Soo Kyoung Kim, FNP
• Sophie Kim
• Tawny Kim, MD
• Yoobyung Kim, LCSW
• Kimball Care
• Stephen Kimball, D.M.D
• Juanita Kimberly
• Lynn Ray Kime, MD

• Oral and Maxillofacial Surgery (Dentist) in El Paso, TX
• Providers in El Paso, TX by specialty
• Oral and Maxillofacial Surgery (Dentist) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2026; 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.