Stephanie Kim

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN015647 Issued in GA

Practice address

4250 Roswell Rd Ste 110
Marietta, GA 30062-8114

Phone

(770) 509-5585

NPI assigned

Jun 6, 2018

Sex

Female

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.

• Johnson Ferry Dentistry, PC

  • Dentist
  • Marietta, GA
  • NPI 1275967663
  NPD (past)

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

{
    "created_epoch": "1528243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528243200000",
    "number": "1255823175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3097 MAPLE DR NE APT 544",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303053056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4250 ROSWELL RD STE 110",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300628114",
            "telephone_number": "770-509-5585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "STEPHANIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-06",
        "last_updated": "2018-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN015647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jihae Kim
• Joyce Kim, MD
• Ki Wan Kim, MD
• Minje Kim, FNP
• Seonghyeon Kim, DDS
• Stephen Kim, M.D.
• Kay Ann Kimball, CNP
• Johanna Kimberl, PA-C
• Kimberly Wallace LPC LLC
• Candance Kimbrough-Green, M.D.

• General Practice Dentistry in Marietta, GA
• Providers in Marietta, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2018; 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.