Shiwoo Kim, D.M.D

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DDS100351 Issued in CA

Practice address

15823 Westminster Way N
Shoreline, WA 98133-5928

Phone

(213) 590-5686

NPI assigned

Nov 7, 2016

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 11, 2024 through Nov 11, 2026

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.

• Green Lake Oral & Facial Surgery

  • Dentist
  • Shoreline, WA
  • NPI 1457008435
  NPD
• Jawnt Oral Surgery

  • Oral and Maxillofacial Surgery Clinic/Center
  • Shoreline, WA
  • NPI 1023766565
  NPD

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

{
    "created_epoch": "1478476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789430400000",
    "number": "1255873345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15823 WESTMINSTER WAY",
            "city": "N SHORELINE",
            "state": "WA",
            "postal_code": "981134761",
            "telephone_number": "213-590-5686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15823 WESTMINSTER WAY N",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981335928",
            "telephone_number": "213-590-5686"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5731 E Santa Ana Canyon Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Anaheim",
            "state": "CA",
            "postal_code": "928073234",
            "country_code": "US",
            "telephone_number": "714-998-2956",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3660 Grand Ave Ste C",
            "address_purpose": "LOCATION",
            "city": "Chino Hills",
            "state": "CA",
            "postal_code": "917091477",
            "country_code": "US",
            "telephone_number": "909-364-0001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "SHIWOO",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-11-07",
        "last_updated": "2026-09-15",
        "certification_date": "2026-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "DDS100351",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE61424421",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hang Sig Kim, M.D.
• Hanna S Kim, DDS
• Joohee Kim, MD
• Kyunghwa Kim, CNA
• Phil P Kim, PHARM D.
• Stephen Sung Kim
• Erik Anthony Kimbrel
• Soon H Kimm, M.D.
• Lynndee King
• Paulette King

• Oral and Maxillofacial Surgery (Dentist) in Shoreline, WA
• Providers in Shoreline, WA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2026; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.