Alen Crystal Kim

Primary specialty

DentistTaxonomy code 122300000X

License

12298 Issued in GA

Practice address

3592 Highway 138 SE
Stockbridge, GA 30281-4171

Phone

(770) 506-3955

Fax

(770) 506-3225

NPI assigned

Jan 24, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

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

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609921295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3592 HIGHWAY 138 SE",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302814171",
            "telephone_number": "770-789-4511",
            "fax_number": "770-506-3255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3592 HIGHWAY 138 SE",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302814171",
            "telephone_number": "770-506-3955",
            "fax_number": "770-506-3225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "ALEN",
        "middle_name": "CRYSTAL",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "12298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTIST STATE LICENSE",
            "identifier": "12298",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fahad Khan, MD
• Ramsha Rehan Khan, PAC
• Navita Khatri, DPM
• Kids First Pediatric Group, LLC
• Lindsey Kiesgen, AU.D.
• Diana Kim, D.O.
• Sora Kim
• Daphene Luvata Kimball-Butler, RN.PCM.CLC.SANE.
• Nia Louise Kimbro, FNP
• Joshua A King, MD

• All providers in Stockbridge, GA
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.