Active NPI
Janie Kim, D.D.S.
- General Practice Dentistry
- Chicago, IL
National Provider Identifier
1265732416
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019022591
- Practice address
- 4108 N Sheridan Rd
Chicago, IL 60613-2007 - Phone
- (773) 549-6116
- Fax
- (773) 549-8109
- NPI assigned
- Oct 21, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019022591 | IL | Primary |
Addresses
Primary practice location
4108 N Sheridan Rd
Chicago, IL 60613-2007
Mailing address
4108 N Sheridan Rd
Chicago, IL 60613-2007
Phone (773) 549-6116
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160425002512 | IL | Order and Referring Only - Dentist | 3375842347 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019022591 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287619200000",
"number": "1265732416",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4108 N SHERIDAN RD",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606132007",
"telephone_number": "773-549-6116",
"fax_number": "773-549-8109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4108 N SHERIDAN RD",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606132007",
"telephone_number": "773-549-6116",
"fax_number": "773-549-8109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JANIE",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-10-21",
"last_updated": "2010-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019022591",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2010; 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.