Stewart Y Kim, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

056941 Issued in NY

Practice address

10 Mariel CT
Centereach, NY 11720-4373

Phone

(917) 645-2555

NPI assigned

May 7, 2012

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1336348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729728000000",
    "number": "1548529928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 MARIEL CT",
            "city": "CENTEREACH",
            "state": "NY",
            "postal_code": "117204373",
            "telephone_number": "917-645-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 MARIEL CT",
            "city": "CENTEREACH",
            "state": "NY",
            "postal_code": "117204373",
            "telephone_number": "917-645-2555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "STEWART",
        "middle_name": "Y",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-07",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "11052",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "056941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen a Nagle DMD PC
• Cynthia B Kealey, APRN BC PSYCH CLINIC
• Leighana Keefe, RN
• Patrick Keller, PTA
• Rachael Khanimova, MFT-INTERN
• Jodi Klein, PT
• Kurt Knoll, DPT
• Jasjit S Kochar, MD
• Jamie J Kochmann
• Sabrina Ann Koji, DPT PT

• General Practice Dentistry in Centereach, NY
• Providers in Centereach, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.