Eugene Kim, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

4101 Issued in ME

Practice address

1 College St
Portland, ME 04103-2617

Phone

(207) 221-4747

NPI assigned

Apr 24, 2007

Last updated

Feb 9, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ME

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dental Wellness PA LLC

  dba Dental Wellness of Portland

  • General Practice Dentistry
  • Portland, ME
  • NPI 1699421800
  NPD Authorized official

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644364800000",
    "number": "1417176157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 RANGE RD",
            "city": "CUMBERLAND CENTER",
            "state": "ME",
            "postal_code": "040213433",
            "telephone_number": "207-274-3167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 COLLEGE ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041032617",
            "telephone_number": "207-221-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "EUGENE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-24",
        "last_updated": "2022-02-09",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ME",
            "license": "4101",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS035713",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alan Kilby, MD
• Kaylah Kilby
• Christopher Kilfoil, DC
• Sarah Killingbeck
• Chin Kim, DDS
• Marina Kim, D.O.
• Paul S. Kim, M.D.
• Yun Ae Kim, D.M.D
• Katie Kimball, LCPC-C
• Peter Jeffers Kimball Jr., LCSW

• Dentist in Portland, ME
• Providers in Portland, ME by specialty
• Dentist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2022; 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.