Active NPI
Sung Ryul Kim, DMD
- Prosthodontics
- New York, NY
National Provider Identifier
1407683873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 064078
- Practice address
- 630 W 168TH St
New York, NY 10032-3725 - Phone
- (212) 305-6100
- NPI assigned
- Sep 18, 2024
- 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 |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 064078 | NY | Primary |
Addresses
Primary practice location
630 W 168TH St
New York, NY 10032-3725
Mailing address
630 W 168TH St
New York, NY 10032-3725
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 |
|---|---|---|---|
| 064078 | NY | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1726617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730937600000",
"number": "1407683873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 W 168TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100323725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 W 168TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100323725",
"telephone_number": "212-305-6100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SUNG RYUL",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-09-18",
"last_updated": "2024-11-07",
"certification_date": "2024-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "NY",
"license": "064078",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.