J. Kim Periodontics, LLC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DN13917 Issued in FL

Legal business name

J. KIM PERIODONTICS, LLC

Practice address

4570 S Clyde Morris Blvd
Suite 1
Port Orange, FL 32129-5401

Phone

(386) 322-4867

NPI assigned

Apr 2, 2007

Last updated

Sep 28, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jeffrey M Kim, DDSNPI 1982974135

Title

Owner

Phone

(386) 322-4867

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeffrey Mark Kim, DDS

  • Periodontics
  • Port Orange, FL
  • NPI 1982974135
  NPD (past) Authorized official

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190937600000",
    "number": "1629198551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4570 S CLYDE MORRIS BLVD",
            "address_2": "SUITE 1",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321295401",
            "telephone_number": "386-322-4867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4570 S CLYDE MORRIS BLVD",
            "address_2": "SUITE 1",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321295401",
            "telephone_number": "386-322-4867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J. KIM PERIODONTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2007-09-28",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-322-4867",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "DN13917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Periodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2007; 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.