NPIMap

Organization Active NPI

John G Clinthorne DDS Ms & Heawon Ludia Kim DMD Ms PC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Ann Arbor, MI
National Provider Identifier
1609988153
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
2901012468 Issued in MI
Legal business name
JOHN G CLINTHORNE DDS MS & HEAWON LUDIA KIM DMD MS PC
Practice address
1303 Packard St
Suite 101
Ann Arbor, MI 48104-3814
Phone
(734) 761-3116
Fax
(734) 761-5263
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Heawon Ludia Kim, DMD MSNPI 1255533105
Title
Secretary Treasurer of PC
Phone
(734) 761-3116

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X 2901016885 MI
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X 2901012468 MI Primary

Addresses

Primary practice location

1303 Packard St
Suite 101
Ann Arbor, MI 48104-3814

Mailing address

1303 Packard St
Suite 101
Ann Arbor, MI 48104-3814
Phone (734) 761-3116

National Provider Directory

National Provider Directory

Locations

1303 Packard St
Ste 101
Ann Arbor, MI 48104
Phone (734) 761-3116

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609988153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1303 PACKARD ST",
            "address_2": "SUITE 101",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481043814",
            "telephone_number": "734-761-3116",
            "fax_number": "734-761-5263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1303 PACKARD ST",
            "address_2": "SUITE 101",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481043814",
            "telephone_number": "734-761-3116",
            "fax_number": "734-761-5263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN G CLINTHORNE DDS MS & HEAWON LUDIA KIM DMD MS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "HEAWON",
        "authorized_official_middle_name": "LUDIA",
        "authorized_official_title_or_position": "SECRETARY TREASURER OF PC",
        "authorized_official_telephone_number": "734-761-3116",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD MS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MI",
            "license": "2901016885",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MI",
            "license": "2901012468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.