Mi Hyun Kim, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN013642 Issued in GA

Practice address

2765 Collins Hill Rd
Lawrenceville, GA 30043

Phone

(770) 630-5730

NPI assigned

Aug 25, 2006

Last updated

Feb 17, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Mia Hyun Kim Other name

Medicare fee-for-service enrollment

Enrolled in GA

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

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424131200000",
    "number": "1528176252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2765 COLLINS HILL RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "30043",
            "telephone_number": "770-630-5730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2765 COLLINS HILL RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "30043",
            "telephone_number": "770-630-5730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MI",
        "middle_name": "HYUN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-25",
        "last_updated": "2015-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "7823",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN013642",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD NC",
            "identifier": "9025Y",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5903232",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIA",
            "last_name": "KIM",
            "middle_name": "HYUN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• James Hankil Kim, MD
• Jessica Ann Kim
• Jessica Jin-Young Kim
• Ji Young Kim, PHARMD
• Kyung Mee Kim
• Mi Kyung Kim, DPM
• Michael C. Kim, PT
• Min Jung Kim, MD
• Minju Kim, APRN
• Paul Kim, DO

• General Practice Dentistry in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2015; 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.