Active NPI
Mijung Kim
- General Practice Dentistry
- South Portland, ME
National Provider Identifier
1376981258
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DEN4315
- Practice address
- 85 Western Ave
#3
South Portland, ME 04106-2423 - Phone
- (207) 408-0479
- Fax
- (207) 541-9304
- NPI assigned
- Jun 12, 2013
- Last updated
- Jun 12, 2013
- 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 | DEN4315 | ME | Primary |
Addresses
Primary practice location
85 Western Ave
#3
South Portland, ME 04106-2423
Mailing address
85 Western Ave
#3
South Portland, ME 04106-2423
Phone (207) 408-0479
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 |
|---|---|---|---|
| DEN4315 | ME | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. Kim DMD, PLLC | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Dental Clinic/Center
- Pittsboro, NC
- NPI 1841920600
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1370995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370995200000",
"number": "1376981258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "85 WESTERN AVE",
"address_2": "#3",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041062423",
"telephone_number": "207-408-0479",
"fax_number": "207-541-9304"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "85 WESTERN AVE",
"address_2": "#3",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041062423",
"telephone_number": "207-408-0479",
"fax_number": "207-541-9304"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MIJUNG",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-12",
"last_updated": "2013-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "ME",
"license": "DEN4315",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.