Active NPI
Jaewon Kim
- Periodontics
- Oklahoma City, OK
National Provider Identifier
1558032995
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- F-021
- Practice address
- 1201 N Stonewall Ave # 524D
Oklahoma City, OK 73117-1214 - Phone
- (405) 271-7020
- NPI assigned
- Sep 24, 2021
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | F-021 | OK | Primary |
Addresses
Primary practice location
1201 N Stonewall Ave # 524D
Oklahoma City, OK 73117-1214
Mailing address
1201 N Stonewall Ave # 524D
Oklahoma City, OK 73117-1214
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective May 14, 2026 through May 14, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F-021 | OK | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632441600000",
"number": "1558032995",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 N STONEWALL AVE # 524D",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731171214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 N STONEWALL AVE # 524D",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731171214",
"telephone_number": "405-271-7020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JAEWON",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-09-24",
"last_updated": "2021-09-24",
"certification_date": "2021-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "OK",
"license": "F-021",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2021; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.