Soo-Keun Sean Kim, DMD, MD

Primary specialty

DentistTaxonomy code 122300000X

License

064594 Issued in NY

Practice address

2975 Westchester Ave Ste G02
Purchase, NY 10577-2500

Phone

(914) 251-0313

NPI assigned

Apr 19, 2018

Last updated

Jun 10, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Oral SurgeryAlso: Maxillofacial Surgery

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989

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.

• St. Barnabas Hospital

  dba St. Barnabas Hospital Dental Department

  • Dentist
  • Bronx, NY
  • NPI 1477228971
  Medicare reassignment NPD
• St. Barnabas Hospital

  • Community/Retail Pharmacy
  • Bronx, NY
  • NPI 1326794173
  NPD
• St. Barnabas Hospital

  • General Acute Care Hospital
  • Bronx, NY
  • NPI 1326148669
  NPD (past)
• St. Barnabas Hospital

  • General Acute Care Hospital
  • Bronx, NY
  • NPI 1548367873
  NPD (past)

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

{
    "created_epoch": "1524096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749513600000",
    "number": "1316434947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2975 WESTCHESTER AVE STE G02",
            "city": "PURCHASE",
            "state": "NY",
            "postal_code": "105772500",
            "telephone_number": "914-251-0313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2975 WESTCHESTER AVE STE G02",
            "city": "PURCHASE",
            "state": "NY",
            "postal_code": "105772500",
            "telephone_number": "914-251-0313"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "31 Briarfield Dr",
            "address_purpose": "LOCATION",
            "city": "Great Neck",
            "state": "NY",
            "postal_code": "110201409",
            "country_code": "US",
            "telephone_number": "516-241-4454",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "SOO-KEUN",
        "middle_name": "SEAN",
        "credential": "DMD, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-19",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "064594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martin David Keltz, M.D.
• Sandra Kesh, MD
• Jessica Kim-Vaghela, D.O.
• Arthur Kim, DMD
• Jane Kim, MD
• Jacqueline P Kinsley, MAT, TOD
• Jesse Marie Klein, COTA/L
• Cathleen Mary Kneidl, PHYSICIAN ASSISTANT
• Alfrida Kola, NP
• Soujaniya Konada, PT

• Dentist in Purchase, NY
• Providers in Purchase, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.