Kyuan Kim, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

60698462 Issued in WA

Practice address

15224 Main St Ste 300
Mill Creek, WA 98012-7332

Phone

(425) 379-8020

NPI assigned

Jul 17, 2015

Last updated

Nov 18, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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": "1437091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479427200000",
    "number": "1639553795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 112TH AVE NE",
            "address_2": "APT 801",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980045824",
            "telephone_number": "217-979-3943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15224 MAIN ST STE 300",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980127332",
            "telephone_number": "425-379-8020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "KYUAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-17",
        "last_updated": "2016-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "60698462",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12012380A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Isabella Donn Kelly-Escario, LMT
• Clifton Kelly, LMHC
• Richard J Kenny, M.D.
• Vanny Khy-Preston
• Donald Kim, D.D.S,
• Susan Kim, RPH
• Sarah King, LMP
• Julie Linn Kinsman, AU.D.
• Ryan Kippes
• Sarah Klippel, N.D.

• General Practice Dentistry in Mill Creek, WA
• Providers in Mill Creek, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2016; 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.