Alexander Y Kim, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

14181273-9926 Issued in UT

Practice address

36000 Shoemaker Lane
Suite 1051
Fort Cavazos, TX 76544

Phone

(254) 287-2705

NPI assigned

Jul 12, 2017

Last updated

Oct 21, 2024By the provider in NPPES

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

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wolf Ranch Dental Group, PC

  dba Wolf Ranch Dental Group

  • Dentist
  • Georgetown, TX
  • NPI 1588188304
  NPD (past)
• Hillsboro Modern Dentistry, PC

  dba Hillsboro Modern Dentistry

  • General Practice Dentistry
  • Hillsboro, OR
  • NPI 1588095772
  NPD (past)

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

{
    "created_epoch": "1499817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1598287484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 LEANING OAK LN",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786282544",
            "telephone_number": "847-636-7612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36000 SHOEMAKER LANE",
            "address_2": "SUITE 1051",
            "city": "FORT CAVAZOS",
            "state": "TX",
            "postal_code": "76544",
            "telephone_number": "254-287-2705"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1135 W University Ave",
            "address_purpose": "LOCATION",
            "city": "Georgetown",
            "state": "TX",
            "postal_code": "786285313",
            "country_code": "US",
            "telephone_number": "512-240-6623",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2790 NW 188th Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "Hillsboro",
            "state": "OR",
            "postal_code": "971247449",
            "country_code": "US",
            "telephone_number": "503-844-0700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "ALEXANDER",
        "middle_name": "Y",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-12",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D10680",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "36616",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "14181273-9926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Travanti N Jones
• Brett Kaplan, MD
• Erika Frances Karsch
• Tracye Evette Kately
• Adam J Kieffer, PA, RD, PHD
• Nam Kwon Kim, DDS
• Cassandra Marie Klink, OTD, OTR/L
• Kelly Eileen Knapp, PT, DPT, CSCS
• Nickalous Alexander Korbut, LCSW
• Rada-Mayya K Kostadinova

• General Practice Dentistry in Fort Cavazos, TX
• Providers in Fort Cavazos, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.