Active NPI
Kathy Dipasquale Kim, D.D.S.
- General Practice Dentistry
- Rockville, MD
National Provider Identifier
1609209477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 15447
- Practice address
- 15200 Shady Grove Rd Ste 408
Rockville, MD 20850-3218 - Phone
- (301) 926-4408
- NPI assigned
- Aug 15, 2013
- Sex
- Female
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 15447 | MD | Primary |
Addresses
Primary practice location
15200 Shady Grove Rd Ste 408
Rockville, MD 20850-3218
Mailing address
11716 Pindell Chase Dr
Fulton, MD 20759-9704
Phone (410) 979-4902
Other practice location 1
7135 Minstrel Way Ste 101
Columbia, MD 21045-5293
Phone (443) 832-3305
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 |
|---|---|---|---|
| 15447 | MD | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakeside Smiles, LLC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Columbia, MD
- NPI 1841750965
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553385600000",
"number": "1609209477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11716 PINDELL CHASE DR",
"city": "FULTON",
"state": "MD",
"postal_code": "207599704",
"telephone_number": "410-979-4902"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15200 SHADY GROVE RD STE 408",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208503218",
"telephone_number": "301-926-4408"
}
],
"practiceLocations": [
{
"address_1": "7135 Minstrel Way Ste 101",
"address_purpose": "LOCATION",
"city": "Columbia",
"state": "MD",
"postal_code": "210455293",
"country_code": "US",
"telephone_number": "443-832-3305",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIM",
"first_name": "KATHY",
"middle_name": "DIPASQUALE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-15",
"last_updated": "2019-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MD",
"license": "15447",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.