Active NPI
Joshua Jeongwan Kim, DMD
- General Practice Dentistry
- Philadelphia, PA
National Provider Identifier
1487437968
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DS044160
- Practice address
- 3700 Market St Ste 101
Philadelphia, PA 19104-3173 - Phone
- (215) 387-0883
- NPI assigned
- Aug 17, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 22DI03019500 | NJ | |
| General Practice Dentistry | 1223G0001X | DS044160 | PA | Primary |
Addresses
Primary practice location
3700 Market St Ste 101
Philadelphia, PA 19104-3173
Mailing address
275 S Bryn Mawr Ave Apt K40
Bryn Mawr, PA 19010-4249
Phone (609) 933-3233
Other practice location 1
875 Route 73 N Ste H
Marlton, NJ 08053-1273
Phone (856) 983-9300
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 |
|---|---|---|---|
| 22DI03019500 | NJ | MD | Dentist |
| DS044160 | PA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dental Choice, PC | Dentist | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714348800000",
"number": "1487437968",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "275 S BRYN MAWR AVE APT K40",
"city": "BRYN MAWR",
"state": "PA",
"postal_code": "190104249",
"telephone_number": "609-933-3233"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3700 MARKET ST STE 101",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191043173",
"telephone_number": "215-387-0883"
}
],
"practiceLocations": [
{
"address_1": "875 Route 73 N Ste H",
"address_purpose": "LOCATION",
"city": "Marlton",
"state": "NJ",
"postal_code": "080531273",
"country_code": "US",
"telephone_number": "856-983-9300",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIM",
"first_name": "JOSHUA",
"middle_name": "JEONGWAN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-17",
"last_updated": "2024-04-29",
"certification_date": "2023-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "22DI03019500",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "PA",
"license": "DS044160",
"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 Apr 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.