NPIMap

Individual provider Active NPI

Chun Kim

  • Dentist
  • Salt Lake City, UT
National Provider Identifier
1407273121
Registry record updated Mar 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8586670-9922 Issued in UT
Practice address
4010 S 700 E #5
Salt Lake City, UT 84107
Phone
(801) 262-0915
Fax
(801) 262-0812
NPI assigned
Mar 19, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 8586670-9922 UT Primary

Addresses

Primary practice location

4010 S 700 E #5
Salt Lake City, UT 84107

Mailing address

4010 S 700 E #5
Salt Lake City, UT 84107
Phone (801) 262-0915

Other identifiers 1

IdentifierTypeStateIssuer
1760748826MedicaidUT

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
8586670-9922UTMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Grace Family Dental Dentist Past 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1395187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395187200000",
    "number": "1407273121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4010 S 700 E #5",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84107",
            "telephone_number": "801-262-0915",
            "fax_number": "801-262-0812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4010 S 700 E #5",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84107",
            "telephone_number": "801-262-0915",
            "fax_number": "801-262-0812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "CHUN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-19",
        "last_updated": "2014-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "8586670-9922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760748826",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2014; 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.