NPIMap

Organization Active NPI

Kwang W Kim, DDS, PLLC

  • General Practice Dentistry
  • South Boston, VA
National Provider Identifier
1255061909
Registry record updated Jun 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
KWANG W KIM, DDS, PLLC
Practice address
410 Mineral St
South Boston, VA 24592-3716
Phone
(434) 572-4928
Fax
(434) 575-0302
NPI assigned
Jun 15, 2022
Last updated
Jun 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2022

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

Authorized official

Name
Dr. Kwang Kim, DDSNPI 1972824936
Title
Dentist
Phone
(434) 572-4928

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

410 Mineral St
South Boston, VA 24592-3716

Mailing address

410 Mineral St
South Boston, VA 24592-3716
Phone (434) 572-4928

National Provider Directory

National Provider Directory

Locations

410 Mineral St
South Boston, VA 24592
Phone (434) 572-4928

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1655251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655251200000",
    "number": "1255061909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 MINERAL ST",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245923716",
            "telephone_number": "434-572-4928",
            "fax_number": "434-575-0302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 MINERAL ST",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245923716",
            "telephone_number": "434-572-4928",
            "fax_number": "434-575-0302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KWANG W KIM, DDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-15",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "KWANG",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "434-572-4928",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Boston, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.