Individual provider Active NPI

Jungsoo Kim, DDS

  • Pediatric Dentistry
  • San Francisco, CA
National Provider Identifier
1295466126
Registry record updated Jun 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DDS104691 Issued in CA
Practice address
1249 18TH Ave Apt 301
San Francisco, CA 94122-1867
Phone
(646) 345-2530
NPI assigned
Jun 21, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X DDS104691 CA Primary

Addresses

Primary practice location

1249 18TH Ave Apt 301
San Francisco, CA 94122-1867

Mailing address

1249 18TH Ave Apt 301
San Francisco, CA 94122-1867
Phone (646) 345-2530

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241015004363 CA Practitioner - Pediatric Dentistry 9830621838 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DDS104691CAMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
University of California San Francisco CurrentSince Sep 26, 2024 Accepting new patients
UCSF Medical Group Business Services CurrentSince Sep 26, 2024 Accepting new patients
UCSF Oral Medicine Clinic CurrentSince Sep 26, 2024 Accepting new patients
UCSF Oral & Maxillofacial Surgery CurrentSince Sep 26, 2024 Accepting new patients
UCSF Medical Group Business Services CurrentSince Sep 26, 2024 Accepting new patients
University of California San Francisco CurrentSince Sep 26, 2024 Accepting new patients
University of California San Francisco Medical Center Past Accepting new patients
University of California San Francisco Past Accepting new patients

Locations

400 Parnassus Ave
#A632
San Francisco, CA 94143
Phone (415) 473-1000

707 Parnassus Ave
Fl 1
San Francisco, CA 94143

513 Parnassus Ave
Rm S722
San Francisco, CA 94143
Phone (415) 476-2045

1975 4th St
San Francisco, CA 94143
Phone (415) 353-3000

513 Parnassus Ave
San Francisco, CA 94143
Phone (415) 476-1239

707 Parnassus Ave
San Francisco, CA 94143
Phone (415) 476-3028

2330 Post St
San Francisco, CA 94115
Phone (415) 502-4444

2001 The Embarcadero
Ofc Of
San Francisco, CA 94143
Phone (628) 224-5503

Interoperability endpoints

  • Direct secure messaging: jkim115130@direct-ucsfmedicalcenter.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1655769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655769600000",
    "number": "1295466126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1249 18TH AVE APT 301",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941221867",
            "telephone_number": "646-345-2530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1249 18TH AVE APT 301",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941221867",
            "telephone_number": "646-345-2530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JUNGSOO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-21",
        "last_updated": "2022-06-21",
        "certification_date": "2022-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "DDS104691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

Verify at the official NPI Registry.