Jason Minje Kim, DDS
Individual provider Active NPI General Practice Dentistry · West Milwaukee, WI
NPI 1407547151 · NPPES record last updated Jul 25, 2023
Key facts
- NPI
- 1407547151
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 6001179-15 (WI)
- Practice address
- 2100 Miller Park Way
West Milwaukee, WI 53219-1641 - Phone
- (317) 965-9259
- NPI assigned
- May 15, 2023
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6001179-15 | WI | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program |
390200000X | |||
| General Practice Dentistry | 1223G0001X | 6001179-15 | WI | Yes |
Addresses
Primary practice location
2100 Miller Park Way
West Milwaukee, WI 53219-1641
Mailing address
161 W Wisconsin Ave Apt 214
Milwaukee, WI 53203-2605
Phone (317) 965-9259
Other providers in West Milwaukee, WI
- Regina Hunter
- Ami Inoue
- Renee Rochelle Johnson
- Kayla S Jones
- Patrick R Kaul
- Sean Matthew Kita
- Rachael Knudsen
- Preetha Y Kurudiyara
- Labworks, LLC
- Sharada K Lange
All providers in West Milwaukee, WI · General Practice Dentistry in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 25, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.