Sean Youngsan Kim, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D4311 Issued in AZ

Practice address

5115 N Dysart Rd
Ste 218
Litchfield Park, AZ 85340

Phone

(623) 536-0900

Fax

(623) 536-0920

NPI assigned

Apr 25, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

Practice roles

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.

• Horizon Modern Dentistry and Orthodontics, LLP

  • General Practice Dentistry
  • Scottsdale, AZ
  • NPI 1922314202
  NPD (past) Authorized official
• Suncoast Dental Inc

  • General Practice Dentistry
  • Surprise, AZ
  • NPI 1568518587
  NPD (past)

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242950400000",
    "number": "1497974448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13706 W BELL RD",
            "address_2": "STE 2",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "85374",
            "telephone_number": "623-584-9910",
            "fax_number": "623-584-9940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5115 N DYSART RD",
            "address_2": "STE 218",
            "city": "LITCHFIELD PARK",
            "state": "AZ",
            "postal_code": "85340",
            "telephone_number": "623-536-0900",
            "fax_number": "623-536-0920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SEAN",
        "middle_name": "YOUNGSAN",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-25",
        "last_updated": "2009-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "4311",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D4311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Keegan
• Samantha Lynn Kelley
• Valerie Ann Kemper, PSY.D.
• William John Kennell, M.D.
• Andrea Marie Kessler, FNP-C
• Joseph King, PHARMD
• Shelly F Kirk, NP
• Jennifer Lynn Klauschie, M.D.
• Danessa R Klemme, RBT
• Kerry M Knight, PAC

• Dentist in Litchfield Park, AZ
• Providers in Litchfield Park, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2009; 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.