Mitchell Kim, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22246 Issued in TX

Practice address

3610 Shire Blvd
Suite 204
Richardson, TX 75082-2241

Phone

(972) 578-6633

Fax

(972) 578-6637

NPI assigned

Mar 22, 2007

Last updated

Jun 6, 2013By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Modern Dental

  • Dental Clinic/Center
  • Richardson, TX
  • NPI 1780998443
  NPD (past) Authorized official

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370476800000",
    "number": "1437275047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3610 SHIRE BLVD",
            "address_2": "SUITE 204",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750822241",
            "telephone_number": "972-578-6633",
            "fax_number": "972-578-6637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3610 SHIRE BLVD",
            "address_2": "SUITE 204",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750822241",
            "telephone_number": "972-578-6633",
            "fax_number": "972-578-6637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MITCHELL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-22",
        "last_updated": "2013-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "22246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neeraja Kikkeri, D.D.S.
• Karyn Kilroy, CCC SLP
• Janet Kim-Way
• Jinsoo Kim, DDS
• Kevin Kim, M.D.
• Tae H Kim, DDS
• Woan Sang Kim, DO
• Yoori Kim, D.D.S
• David Dee Kinard, CNS
• King Surgical Consultants LLC (Core Compression)

• General Practice Dentistry in Richardson, TX
• Providers in Richardson, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.