Active NPI
Donghyun Kim
- General Practice Dentistry
- Brooklyn, NY
National Provider Identifier
1376100289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 061307
- Practice address
- 408 Knickerbocker Ave # 2ND
Brooklyn, NY 11237-4102 - Phone
- (718) 573-3333
- NPI assigned
- May 27, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| General Practice Dentistry | 1223G0001X | 061307 | NY | Primary |
Addresses
Primary practice location
408 Knickerbocker Ave # 2ND
Brooklyn, NY 11237-4102
Mailing address
2375 Bell Blvd Apt 1
Bayside, NY 11360-2004
Phone (347) 229-3816
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 |
|---|---|---|---|
| 061307 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638921600000",
"number": "1376100289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2375 BELL BLVD APT 1",
"city": "BAYSIDE",
"state": "NY",
"postal_code": "113602004",
"telephone_number": "347-229-3816"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "408 KNICKERBOCKER AVE # 2ND",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112374102",
"telephone_number": "718-573-3333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "DONGHYUN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-27",
"last_updated": "2021-12-08",
"certification_date": "2021-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "061307",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 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.