Active NPI
Youngchul Kim
- General Practice Dentistry
- Baltimore, MD
National Provider Identifier
1629384987
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 14672
- Practice address
- 2401 Belair Rd Ste 104
Baltimore, MD 21213-1200 - Phone
- (617) 304-9839
- NPI assigned
- Aug 25, 2010
- Sex
- Male
- 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 | 14672 | MD | Primary |
Addresses
Primary practice location
2401 Belair Rd Ste 104
Baltimore, MD 21213-1200
Mailing address
430 W Erie St Ste 200
Chicago, IL 60654-6920
Phone (920) 838-1649
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 |
|---|---|---|---|
| 14672 | MD | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282694400000",
"number": "1629384987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "430 W ERIE ST STE 200",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606546920",
"telephone_number": "920-838-1649"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2401 BELAIR RD STE 104",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212131200",
"telephone_number": "617-304-9839"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "YOUNGCHUL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-08-25",
"last_updated": "2010-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MD",
"license": "14672",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.