Active NPI
Matthew Min Kyu Kim, DDS
- Dentist
- Stamford, CT
National Provider Identifier
1396943379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 054305
- Practice address
- 121 Towne St
Stamford, CT 06902-5930 - Phone
- (917) 748-7355
- NPI assigned
- Jul 11, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 054305 | NY | Primary |
Addresses
Primary practice location
121 Towne St
Stamford, CT 06902-5930
Mailing address
121 Towne St
Stamford, CT 06902-5930
Phone (917) 748-7355
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03168458 | Medicaid | NY |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376006400000",
"number": "1396943379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "121 TOWNE ST",
"city": "STAMFORD",
"state": "CT",
"postal_code": "069025930",
"telephone_number": "917-748-7355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "121 TOWNE ST",
"city": "STAMFORD",
"state": "CT",
"postal_code": "069025930",
"telephone_number": "917-748-7355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MATTHEW",
"middle_name": "MIN KYU",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-11",
"last_updated": "2013-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "054305",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "03168458",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stamford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 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.