Individual provider Active NPI

Jason Kum, DDS, MSD

  • Periodontics
  • Indianapolis, IN
National Provider Identifier
1417408360
Registry record updated Aug 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
12013251A Issued in IN
Practice address
3003 E 98TH St Ste 200
Indianapolis, IN 46280-1973
Phone
(317) 426-1642
NPI assigned
Oct 15, 2016
Last updated
Aug 1, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X 12013251A IN Primary

Addresses

Primary practice location

3003 E 98TH St Ste 200
Indianapolis, IN 46280-1973

Mailing address

3003 E 98TH St Ste 200
Indianapolis, IN 46280-1973
Phone (317) 843-1281

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12013251AINMDPeriodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Peak Periodontal & Dental Implant Specialists Periodontics CurrentSince Jun 1, 2020 Accepting new patients

Locations

3003 E 98th St
Ste 200
Carmel, IN 46280
Phone (317) 426-1642

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

NPI Registry JSON

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

{
    "created_epoch": "1476489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564617600000",
    "number": "1417408360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3003 E 98TH ST STE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462801973",
            "telephone_number": "317-843-1281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 E 98TH ST STE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462801973",
            "telephone_number": "317-426-1642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUM",
        "first_name": "JASON",
        "name_prefix": "Dr.",
        "credential": "DDS, MSD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-10-15",
        "last_updated": "2019-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IN",
            "license": "12013251A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.