Active NPI
Joo-Won Kim, DDS
- General Practice Dentistry
- Tucker, GA
National Provider Identifier
1265867014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN014661
- Practice address
- 4500 Hugh Howell Rd
Suite 140
Tucker, GA 30084-4723 - Phone
- (770) 938-9090
- NPI assigned
- Sep 12, 2013
- Sex
- Female
- Sole proprietor
- No
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 | DN014661 | GA | Primary |
Addresses
Primary practice location
4500 Hugh Howell Rd
Suite 140
Tucker, GA 30084-4723
Mailing address
4500 Hugh Howell Rd
Suite 140
Tucker, GA 30084-4723
Phone (770) 938-9090
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161021001761 | GA | Order and Referring Only - Other (Non-Physician) | 5193003382 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN014661 | GA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1378944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391472000000",
"number": "1265867014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 HUGH HOWELL RD",
"address_2": "SUITE 140",
"city": "TUCKER",
"state": "GA",
"postal_code": "300844723",
"telephone_number": "770-938-9090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 HUGH HOWELL RD",
"address_2": "SUITE 140",
"city": "TUCKER",
"state": "GA",
"postal_code": "300844723",
"telephone_number": "770-938-9090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JOO-WON",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-09-12",
"last_updated": "2014-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN014661",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucker, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2014; 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.