Active NPI
Sahng Gyoon Kim, D.D.S., M.S.
- Endodontics
- New York, NY
National Provider Identifier
1619201373
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 056438
- Practice address
- 100 Haven Ave
New York, NY 10032-2645 - Phone
- (212) 342-0107
- NPI assigned
- Sep 29, 2009
- Last updated
- Oct 11, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 000009 | NY | |
| Endodontics | 1223E0200X | 056438 | NY | Primary |
Addresses
Primary practice location
100 Haven Ave
New York, NY 10032-2645
Mailing address
630 W 168TH St PH 7Stem
New York, NY 10032-3725
Phone (215) 971-5811
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160621002037 | NY | Order and Referring Only - Other (Physician) | 2062703184 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056438 | NY | MD | Endodontist |
| 000009 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349913600000",
"number": "1619201373",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 W 168TH ST PH 7STEM",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100323725",
"telephone_number": "215-971-5811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 HAVEN AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100322645",
"telephone_number": "212-342-0107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SAHNG GYOON",
"credential": "D.D.S., M.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-09-29",
"last_updated": "2012-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NY",
"license": "000009",
"primary": false
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NY",
"license": "056438",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2012; 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.