Kijin Woo, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

12011208A Issued in IN

Practice address

330 N Jacob Drive
Bloomington, IN 47404

Phone

(812) 323-7400

Fax

(812) 323-7595

NPI assigned

Aug 1, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• CS Dental LLC

  • General Practice Dentistry
  • Bloomington, IN
  • NPI 1225330582
  NPD (past) Authorized official
• LK Dental, LLC

  • General Practice Dentistry
  • Bloomington, IN
  • NPI 1902656556
  NPD (past)

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

{
    "created_epoch": "1217548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217548800000",
    "number": "1396901005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3189",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13220",
            "telephone_number": "866-273-8204",
            "fax_number": "866-571-2509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 N JACOB DRIVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "47404",
            "telephone_number": "812-323-7400",
            "fax_number": "812-323-7595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOO",
        "first_name": "KIJIN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-01",
        "last_updated": "2008-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12011208A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• George K Wolfer Jr., MD
• Leighanne Wolfer, ARNP
• Brent Wolford, RPH
• Hei Jessie Wong, RDN, LD
• Jessica Woo
• Alice B Wood, M.D.
• Jordan D Wood, M.D.
• Marla K Wood, OT
• Karri Jacqueline Woodard
• Theresa Rose Woodard, NP

• Dentist in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.