Active NPI
Jae Kyong Kim, DDS
- Dentist
- Longview, TX
National Provider Identifier
1457032476
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 39882
- Practice address
- 3080 N Eastman Rd Ste 104
Longview, TX 75605-7978 - Phone
- (903) 686-0086
- NPI assigned
- Jul 31, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 39882 | TX | Primary |
Addresses
Primary practice location
3080 N Eastman Rd Ste 104
Longview, TX 75605-7978
Mailing address
9672 Minton Dr
Fort Worth, TX 76108-3887
Phone (817) 914-7037
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39882 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690848000000",
"number": "1457032476",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9672 MINTON DR",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761083887",
"telephone_number": "817-914-7037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3080 N EASTMAN RD STE 104",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756057978",
"telephone_number": "903-686-0086"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JAE KYONG",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-07-31",
"last_updated": "2023-08-01",
"certification_date": "2023-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "39882",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 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.