Active NPI
Siwoo Kim
- Dentist
- Gaithersburg, MD
National Provider Identifier
1558112151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 18849
- Practice address
- 10201 Washingtonian Blvd Apt 514
Gaithersburg, MD 20878-8310 - Phone
- (443) 996-0507
- NPI assigned
- Apr 1, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 18849 | MD | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
10201 Washingtonian Blvd Apt 514
Gaithersburg, MD 20878-8310
Mailing address
5 Cabot Rd Unit 338
Medford, MA 02155-5295
Phone (443) 996-0507
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18849 | MD | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754524800000",
"number": "1558112151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 CABOT RD UNIT 338",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021555295",
"telephone_number": "443-996-0507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10201 WASHINGTONIAN BLVD APT 514",
"city": "GAITHERSBURG",
"state": "MD",
"postal_code": "208788310",
"telephone_number": "443-996-0507"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SIWOO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-04-01",
"last_updated": "2025-08-07",
"certification_date": "2025-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MD",
"license": "18849",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gaithersburg, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.