Active NPI
Jeannette K Kim, DMD
- General Practice Dentistry
- Philadelphia, PA
National Provider Identifier
1467471987
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DS-031351-L
- Practice address
- 1012 Cottman Ave FL 2
Philadelphia, PA 19111-3644 - Phone
- (267) 307-9691
- Fax
- (215) 342-8409
- NPI assigned
- Jul 18, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DS-031351-L | PA | Primary |
Addresses
Primary practice location
1012 Cottman Ave FL 2
Philadelphia, PA 19111-3644
Mailing address
1012 Cottman Ave. 2ND Floor
Philadelphia, PA 19111
Phone (267) 307-9691
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 |
|---|---|---|---|
| DS-031351-L | PA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1467471987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1012 COTTMAN AVE. 2ND FLOOR",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19111",
"telephone_number": "267-307-9691",
"fax_number": "215-342-8409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1012 COTTMAN AVE FL 2",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191113644",
"telephone_number": "267-307-9691",
"fax_number": "215-342-8409"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JEANNETTE",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "PA",
"license": "DS-031351-L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.