Active NPI
Ken Kim
- General Practice Dentistry
- Ellicott City, MD
National Provider Identifier
1477606341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12964
- Practice address
- 8801 Baltimore National Pike #17
Ellicott City, MD 21043 - Phone
- (410) 461-2424
- NPI assigned
- Jan 22, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12964 | MD | Primary |
Addresses
Primary practice location
8801 Baltimore National Pike #17
Ellicott City, MD 21043
Mailing address
8801 Baltimore National Pike Ste 17
Ellicott City, MD 21043-4160
Phone (410) 461-2424
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 |
|---|---|---|---|
| 12964 | MD | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kim & Kim, D.D.S., P.a. | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Ellicott City, MD
- NPI 1043905367
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268092800000",
"number": "1477606341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8801 BALTIMORE NATIONAL PIKE STE 17",
"city": "ELLICOTT CITY",
"state": "MD",
"postal_code": "210434160",
"telephone_number": "410-461-2424"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8801 BALTIMORE NATIONAL PIKE #17",
"city": "ELLICOTT CITY",
"state": "MD",
"postal_code": "21043",
"telephone_number": "410-461-2424"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "KEN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-22",
"last_updated": "2010-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MD",
"license": "12964",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellicott City, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.