Jae Kim, D.D.S

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

12130 Issued in CT

Practice address

144 Boston Ave
Bridgeport, CT 06610-1604

Phone

(203) 437-7561

NPI assigned

Oct 28, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Scarsdale Family Dental Group PC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Scarsdale, NY
  • NPI 1427997337
  NPD Authorized official
• Smile Family Dental Group

  • General Practice Dentistry
  • New York, NY
  • NPI 1720786379
  NPD Authorized official

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

{
    "created_epoch": "1445990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1548632607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1955 LAKE AVE",
            "city": "ALTADENA",
            "state": "CA",
            "postal_code": "910013037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 BOSTON AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066101604",
            "telephone_number": "203-437-7561"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "531 Elm St",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "065114549",
            "country_code": "US",
            "telephone_number": "203-901-1323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "JAE",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-10-28",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "65151",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "65151",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CT",
            "license": "12130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Veronika Kholodovych, MD
• Krishna Chaitanya Kilaru
• Grace P Kim, MD
• Heeryoung Kim, MD
• Hyun S Kim, DC
• Rosy Minhye Kim, DDS
• Young Choi Kim, MD
• Kinetic Rehab, LLC
• Molly King, PA
• Nicole Kingsland, MSN, SRNA

• Orthodontics and Dentofacial Orthopedics Dentistry in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.