Jason Donghyun Kim

Primary specialty

DentistTaxonomy code 122300000X

License

22DI02806400 Issued in NJ

Practice address

542 New York Ave
Lyndhurst, NJ 07071-1532

Phone

(201) 623-3355

NPI assigned

Mar 28, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Dong Hyun Kim Former name

Medicare fee-for-service enrollment

Enrolled in NJ

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

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

{
    "created_epoch": "1553731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630022400000",
    "number": "1467913863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 MOUNTAIN AVE # SC13",
            "city": "SPRINGFIELD",
            "state": "NJ",
            "postal_code": "070813414",
            "telephone_number": "973-506-0159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "542 NEW YORK AVE",
            "city": "LYNDHURST",
            "state": "NJ",
            "postal_code": "070711532",
            "telephone_number": "201-623-3355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 E 210th St",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104672401",
            "country_code": "US",
            "telephone_number": "718-920-4321",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "JASON",
        "middle_name": "DONGHYUN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-28",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02806400",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DONG HYUN",
            "last_name": "KIM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Vaidehi V Kathiria
• Kaufman Chiropractic
• Christian Jude Kaufman, DC
• Mansi V Khunt
• Celeste Hoin Kim, DMD
• Jessica Kim
• Kirk Knutsen, M.S.
• Carly Krupat, LCSW
• Ladder Counseling & Wellness
• Artur Lalik, PTA

• Dentist in Lyndhurst, NJ
• Providers in Lyndhurst, NJ by specialty
• Dentist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 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.