Active NPI
Min Soo Kim, D.M.D
- Dentist
- Aurora, IL
National Provider Identifier
1528449873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12012332A
- Practice address
- 4260 Westbrook Dr Ste 105
Aurora, IL 60504-8136 - Phone
- (630) 851-0450
- NPI assigned
- Jun 12, 2015
- Last updated
- Feb 1, 2024
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12012332A | IN | Primary |
Addresses
Primary practice location
4260 Westbrook Dr Ste 105
Aurora, IL 60504-8136
Mailing address
2701 N Dirksen Pkwy
Springfield, IL 62702-1407
Phone (217) 814-0407
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Dentist
- Education
- Midwestern University College of Dental Medicine, Downers Grove, 2015
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
4260 Westbrook Dr
Suite 105
Aurora, IL 60504-8136
Phone (630) 566-7737
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12012332A | IN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sleep Better Inc | Dentist | Current | Accepting new patients |
| Sleep Better Inc | Current | Accepting new patients |
Locations
4260 Westbrook Dr
Ste 105
Aurora, IL 60504
Phone (630) 566-7737
110 W Center St
Ottawa, IL 61350
Phone (630) 566-7737
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706745600000",
"number": "1528449873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2701 N DIRKSEN PKWY",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627021407",
"telephone_number": "217-814-0407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4260 WESTBROOK DR STE 105",
"city": "AURORA",
"state": "IL",
"postal_code": "605048136",
"telephone_number": "630-851-0450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MIN",
"middle_name": "SOO",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-06-12",
"last_updated": "2024-02-01",
"certification_date": "2024-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12012332A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Aurora, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.