Donald Kim, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DE 7414 Issued in WA

Practice address

965 SW Emkay Drive
Suite 100
Bend, OR 97702

Phone

(541) 383-0754

Fax

(541) 383-8128

NPI assigned

Aug 29, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1427167170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 SW EMKAY DRIVE",
            "address_2": "SUITE 100",
            "city": "BEND",
            "state": "OR",
            "postal_code": "97702",
            "telephone_number": "541-383-0754",
            "fax_number": "541-383-8128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 SW EMKAY DRIVE",
            "address_2": "SUITE 100",
            "city": "BEND",
            "state": "OR",
            "postal_code": "97702",
            "telephone_number": "541-383-0754",
            "fax_number": "541-383-8128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "DONALD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE 7414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keith Killam, LMT
• Kristin Killoran, LPCI
• Kilter Rehabilitation and Performance
• Anne Klein Kilty, ANP/WHNCP
• Caroline Y Kim, LAC
• Janice J. Kim, MD
• Paul Hoon Kim, D.D.S.
• Kimberly D Delaney, Aprn, PSYD, LLC
• Kimberly Richards Counseling, LLC
• Kai Kinder, M.D.

• Dentist in Bend, OR
• Providers in Bend, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; 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.