Active NPI
Mikeong Kim
- General Practice Dentistry
- Desoto, TX
National Provider Identifier
1316627573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 39853
- Practice address
- 921 W Belt Line Rd Ste 117
Desoto, TX 75115-3995 - Phone
- (972) 223-9600
- NPI assigned
- Jul 24, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 39853 | TX | Primary |
Addresses
Primary practice location
921 W Belt Line Rd Ste 117
Desoto, TX 75115-3995
Mailing address
3405 Montgomery Dr Apt 437
Santa Clara, CA 95054-3090
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39853 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690934400000",
"number": "1316627573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3405 MONTGOMERY DR APT 437",
"city": "SANTA CLARA",
"state": "CA",
"postal_code": "950543090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "921 W BELT LINE RD STE 117",
"city": "DESOTO",
"state": "TX",
"postal_code": "751153995",
"telephone_number": "972-223-9600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MIKEONG",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-24",
"last_updated": "2023-08-02",
"certification_date": "2023-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "39853",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Desoto, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.