Individual provider Active NPI

Christine J Kim, DMD

  • Dentist
  • Baltimore, MD
National Provider Identifier
1518442086
Registry record updated Oct 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
17068 Issued in MD
Practice address
1501 Division St
Baltimore, MD 21217-3121
Phone
(410) 383-8300
Fax
(410) 383-3160
NPI assigned
Oct 1, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 17068 MD Primary

Addresses

Primary practice location

1501 Division St
Baltimore, MD 21217-3121

Mailing address

1501 Division St
Baltimore, MD 21217-3121
Phone (410) 383-8300

Other identifiers 1

IdentifierTypeStateIssuer
249654200MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, MD2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20200701000804 PA Practitioner - Dentist 7012330574 Reassigns benefits to 1 organization
I20201008000335 MD Practitioner - Dentist 7012330574 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
17068MDMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Greater Philadelphia Health Action Inc. CurrentSince May 25, 2020 Accepting new patients
Total Health Care Inc CurrentSince Oct 12, 2020 Accepting new patients
Greater Philadelphia Health Action, Inc. CurrentSince May 25, 2020 Accepting new patients
Total Health Care Inc. CurrentSince Oct 12, 2020 Accepting new patients
Greater Philadelphia Health Action Inc. Current Accepting new patients

Locations

1501 W Saratoga St
Baltimore, MD 21223
Phone (410) 383-7197

1111 Washington Blvd
Baltimore, MD 21230
Phone (410) 783-1859

1501 Division St
Baltimore, MD 21217
Phone (410) 735-5390

5501 Woodland Ave
Philadelphia, PA 19143
Phone (215) 724-4700

1401 S 31st St
#2
Philadelphia, PA 19146

1401 S 31st St
Philadelphia, PA 19146
Phone (215) 755-7700

4510 Frankford Ave
Philadelphia, PA 19124
Phone (215) 744-1302

432 N 6th St
Philadelphia, PA 19123
Phone (215) 627-8000

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GJFJBD

Organizations & group practices 5

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": "1538352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635120000000",
    "number": "1518442086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 DIVISION ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212173121",
            "telephone_number": "410-383-8300",
            "fax_number": "410-383-3160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 DIVISION ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212173121",
            "telephone_number": "410-383-8300",
            "fax_number": "410-383-3160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "CHRISTINE",
        "middle_name": "J",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-01",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "17068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "249654200",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.