Sam DK Kim, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60127882 Issued in WA

Practice address

1412 SW 43Rd St
Idc Medical Plaza, #109
Renton, WA 98057-4803

Phone

(253) 277-8767

Fax

(253) 277-8769

NPI assigned

Aug 22, 2011

Last updated

Jan 4, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 WA

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": "1313971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546560000000",
    "number": "1528348695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1412 SW 43RD ST STE 109",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980574803",
            "telephone_number": "253-277-8767",
            "fax_number": "253-277-8769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1412 SW 43RD ST",
            "address_2": "IDC MEDICAL PLAZA, #109",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980574803",
            "telephone_number": "253-277-8767",
            "fax_number": "253-277-8769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SAM",
        "middle_name": "DK",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-22",
        "last_updated": "2019-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60127882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristine Jihae Kim, PHARMD
• Mercedes Gosnell Kim, CNA, SUDP-T
• Mi Sun Kim, APRN
• Natalie Kim, LMFTA
• Richard Dong Suk Kim, MD
• Sang C. Kim, D.D.S
• Sang-Mun Kim
• So Hee Kim, ARNP
• Susan Kim, PHARMD
• Tae Yong Kim, CHIROPRACTOR

• General Practice Dentistry in Renton, WA
• Providers in Renton, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2019; 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.