Paul Hoon Kim, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00010592 Issued in WA

Practice address

461 NE Greenwood Ave
Suite C
Bend, OR 97701

Phone

(541) 678-5060

Fax

(541) 306-4004

NPI assigned

Oct 14, 2006

Last updated

Dec 16, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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

State licenses

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.

• Deeply Rooted Dentistry, LLC

  • General Practice Dentistry
  • Bend, OR
  • NPI 1871205393
  Authorized official Same address or phone

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

{
    "created_epoch": "1160784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671148800000",
    "number": "1477643823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "461 NE GREENWOOD AVE",
            "address_2": "SUITE C",
            "city": "BEND",
            "state": "OR",
            "postal_code": "97701",
            "telephone_number": "541-678-5060",
            "fax_number": "541-306-4004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "461 NE GREENWOOD AVE",
            "address_2": "SUITE C",
            "city": "BEND",
            "state": "OR",
            "postal_code": "97701",
            "telephone_number": "541-678-5060",
            "fax_number": "541-306-4004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "PAUL",
        "middle_name": "HOON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-14",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00010592",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kilter Rehabilitation and Performance
• Anne Klein Kilty, ANP/WHNCP
• Caroline Y Kim, LAC
• Donald Kim, DDS
• Janice J. Kim, MD
• Kimberly D Delaney, Aprn, PSYD, LLC
• Kimberly Richards Counseling, LLC
• Kai Kinder, M.D.
• Amy Fisher King, LCSW
• Anona King

• General Practice Dentistry in Bend, OR
• Providers in Bend, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2022; 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.