Bora Kim, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DE60876116 Issued in WA

Practice address

1019 Beaty Blvd Ste 600
Gallatin, TN 37066-4765

Phone

(615) 989-6611

NPI assigned

May 16, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Dr. N/a N/a N/a Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Glowing Smiles Pediatric Dentistry

  • Pediatric Dentistry
  • Gallatin, TN
  • NPI 1528773538
  NPD Authorized official

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

{
    "created_epoch": "1494892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673654400000",
    "number": "1437686920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 BEATY BLVD STE 600",
            "city": "GALLATIN",
            "state": "TN",
            "postal_code": "370664765",
            "telephone_number": "615-989-6611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019 BEATY BLVD STE 600",
            "city": "GALLATIN",
            "state": "TN",
            "postal_code": "370664765",
            "telephone_number": "615-989-6611"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "410 N Parrish Pl Ste 1000",
            "address_purpose": "LOCATION",
            "city": "Hendersonville",
            "state": "TN",
            "postal_code": "370751003",
            "country_code": "US",
            "telephone_number": "615-991-0184",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "BORA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-16",
        "last_updated": "2023-01-14",
        "certification_date": "2021-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "DE60876116",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1437686920",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "N/A",
            "last_name": "N/A",
            "middle_name": "N/A",
            "prefix": "DR.",
            "credential": "DMD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Samantha Jo Kelly
• Kellie Keown
• Savannah D Ketterer, PA-C
• Wardah Khan, NP
• Suzette Ann Denise Kilgore, M.D.
• Douglas Finn Kimbro
• Jeffrie C Kindred, DO
• Alton S King Jr., M.D.
• Matthew S King, MD
• Justin Andrew Kirby, PHARMD

• Pediatric Dentistry in Gallatin, TN
• Providers in Gallatin, TN by specialty
• Pediatric Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2023; 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.