Michael Ethan Kim, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

053099 Issued in NY

Practice address

5322 Francis Lewis Blvd
2ND Floor
Oakland Gardens, NY 11364-1633

Phone

(201) 575-1153

NPI assigned

Oct 26, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295810554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 455",
            "city": "PALISADES PARK",
            "state": "NJ",
            "postal_code": "076500455",
            "telephone_number": "201-575-1153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5322 FRANCIS LEWIS BLVD",
            "address_2": "2ND FLOOR",
            "city": "OAKLAND GARDENS",
            "state": "NY",
            "postal_code": "113641633",
            "telephone_number": "201-575-1153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MICHAEL",
        "middle_name": "ETHAN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "053099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chang Jong Kim
• Grace Eunhae Kim
• Hojung Kim, RPH
• Ji Young Kim
• John Kim, L.AC
• Tae Jung Kim
• Yeesoon Kim
• KJ Acu & Herbs Corp.
• KJ Acu & Herbs Corp.
• Sandy Robin Kline, OD

• General Practice Dentistry in Oakland Gardens, NY
• Providers in Oakland Gardens, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.