Song B Rhim, D.M.D.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D1034 Issued in GU

Practice address

2133 Pepperrell St
Jbsa Lackland, TX 78236-5313

Phone

(210) 292-2558

NPI assigned

Apr 26, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

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": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609804800000",
    "number": "1336369750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2133 PEPPERRELL ST",
            "city": "JBSA LACKLAND",
            "state": "TX",
            "postal_code": "782365313",
            "telephone_number": "210-292-2558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2133 PEPPERRELL ST",
            "city": "JBSA LACKLAND",
            "state": "TX",
            "postal_code": "782365313",
            "telephone_number": "210-292-2558"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "151 Bodin Cir",
            "address_purpose": "LOCATION",
            "city": "Travis AFB",
            "state": "CA",
            "postal_code": "945351801",
            "country_code": "US",
            "telephone_number": "707-423-7055",
            "fax_number": "707-423-1711",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "374th Medical Group",
            "address_2": "Yokota Air Base",
            "address_purpose": "LOCATION",
            "city": "APO",
            "state": "AP",
            "postal_code": "96326",
            "country_code": "US",
            "telephone_number": "315-225-9700",
            "country_name": "United States",
            "address_type": "MIL"
        }
    ],
    "basic": {
        "last_name": "RHIM",
        "first_name": "SONG",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-26",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "62275",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MD",
            "license": "13473",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "DDS62275",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "GU",
            "license": "D1034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Candice Marie Reiter, DDS
• James Jude Renda, DMD, MS
• Ryan Todd Reusch
• Kristine Rae Reymundo, PHARMD
• Jessica Reynolds, LCSW
• Christiana Rhodes, DMD
• Craig Harding Rhyne Jr., DMD, FACS
• Stephen Charles Richardson II, FNP
• Shane David Riggs, D.O.
• Zoe Ring, DMD

• Periodontics in Jbsa Lackland, TX
• Providers in Jbsa Lackland, TX by specialty
• Periodontics in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2021; 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.