Individual provider Active NPI

Jung Hoon Kim, D.D.S.

  • General Practice Dentistry
  • Lynnwood, WA
National Provider Identifier
1366420002
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE00007969 Issued in WA
Practice address
19108 33Rd Ave W
Suite C
Lynnwood, WA 98036-4728
Phone
(425) 774-9571
Fax
(425) 774-5727
NPI assigned
Jan 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DE00007969 WA Primary

Addresses

Primary practice location

19108 33Rd Ave W
Suite C
Lynnwood, WA 98036-4728

Mailing address

19108 33Rd Ave W
Suite C
Lynnwood, WA 98036-4728
Phone (425) 774-9571

Other identifiers 1

IdentifierTypeStateIssuer
5043930MedicaidWA

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

LicenseStateTypeSpecialty
DE00007969WAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1366420002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19108 33RD AVE W",
            "address_2": "SUITE C",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364728",
            "telephone_number": "425-774-9571",
            "fax_number": "425-774-5727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19108 33RD AVE W",
            "address_2": "SUITE C",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364728",
            "telephone_number": "425-774-9571",
            "fax_number": "425-774-5727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JUNG HOON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-04",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00007969",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5043930",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynnwood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.