Active NPI
Jung-Wan Martin Kim, BSC, DMD
- Dentist
- Minneapolis, MN
National Provider Identifier
1568624815
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D12492
- Practice address
- 515 Delaware Street SE
7-360 Moos Health Science Tower
Minneapolis, MN 55455 - Phone
- (612) 625-6177
- Fax
- (612) 626-2652
- NPI assigned
- Jun 27, 2008
- 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 | D12492 | MN | Primary |
Addresses
Primary practice location
515 Delaware Street SE
7-360 Moos Health Science Tower
Minneapolis, MN 55455
Mailing address
515 Delaware Street SE
7-360 Moos Health Science Tower
Minneapolis, MN 55455
Phone (612) 625-6177
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 |
|---|---|---|---|
| D12492 | MN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214524800000",
"number": "1568624815",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "515 DELAWARE STREET SE",
"address_2": "7-360 MOOS HEALTH SCIENCE TOWER",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55455",
"telephone_number": "612-625-6177",
"fax_number": "612-626-2652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 DELAWARE STREET SE",
"address_2": "7-360 MOOS HEALTH SCIENCE TOWER",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55455",
"telephone_number": "612-625-6177",
"fax_number": "612-626-2652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JUNG-WAN MARTIN",
"name_prefix": "Dr.",
"credential": "BSC, DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-27",
"last_updated": "2008-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D12492",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.