Northstar Professional Group PA

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

Legal business name

NORTHSTAR PROFESSIONAL GROUP PA

Practice address

17075 Cagan Ridge Blvd Ste 103
Clermont, FL 34714-9619

Phone

(818) 523-7253

NPI assigned

Sep 1, 2026

Last updated

Sep 1, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shin Kim, DDSNPI 1154645661

Title

President

Phone

(818) 523-7253

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Shin Joseph Kim, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Camp Pendleton, CA
  • NPI 1154645661
  Authorized official Same address or phone

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

{
    "created_epoch": "1788220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788220800000",
    "number": "1275441008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17075 CAGAN RIDGE BLVD STE 103",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347149619",
            "telephone_number": "818-523-7253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17075 CAGAN RIDGE BLVD STE 103",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347149619",
            "telephone_number": "818-523-7253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSTAR PROFESSIONAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-01",
        "last_updated": "2026-09-01",
        "certification_date": "2026-09-01",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "SHIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-523-7253",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mirla Cristina Nolasco
• Sary Noncent
• Madeline Norckauer
• Nordquist Family Medical Center MD PA
• Clay Nordquist, M.D.
• Juan C Nova, MD
• Coryn Novak, ATC, LAT
• Kevin D Nowicki, MD
• Jamie Nowik, SLPA
• NTC Anesthesia, PA

• Oral & Maxillofacial Surgery (D.M.D.) in Clermont, FL
• Providers in Clermont, FL by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2026; 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.