Jinsoo Kim, DDS

Primary specialty

Dental AnesthesiologyTaxonomy code 1223D0004X

License

28856 Issued in TX

Practice address

4112 E Renner Rd
Richardson, TX 75082-2832

Phone

(972) 480-0800

Fax

(972) 480-0900

NPI assigned

Nov 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459728000000",
    "number": "1316019995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7505 VINEYARD TRL",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750442105",
            "telephone_number": "253-394-4186",
            "fax_number": "888-502-2615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4112 E RENNER RD",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750822832",
            "telephone_number": "972-480-0800",
            "fax_number": "972-480-0900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JINSOO",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2016-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "10618",
            "primary": false
        },
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "TX",
            "license": "28856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alicia Kientz
• Koyt Kifer, LPC, LCDC
• Neeraja Kikkeri, D.D.S.
• Karyn Kilroy, CCC SLP
• Janet Kim-Way
• Kevin Kim, M.D.
• Mitchell Kim, D.D.S.
• Tae H Kim, DDS
• Woan Sang Kim, DO
• Yoori Kim, D.D.S

• Dental Anesthesiology in Richardson, TX
• Providers in Richardson, TX by specialty
• Dental Anesthesiology in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2016; 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.