Soo Jin Kim, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI02555900 Issued in NJ

Practice address

326 Garden St Ste 6
Carlstadt, NJ 07072

Phone

(201) 729-0900

NPI assigned

Aug 19, 2008

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1219104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567641600000",
    "number": "1649427865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "326 GARDEN ST STE 6",
            "city": "CARLSTADT",
            "state": "NJ",
            "postal_code": "070721626",
            "telephone_number": "201-729-0900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "326 GARDEN ST STE 6",
            "city": "CARLSTADT",
            "state": "NJ",
            "postal_code": "07072",
            "telephone_number": "201-729-0900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SOO JIN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-19",
        "last_updated": "2019-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02555900",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "053948",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aisha Javed
• Jel Physical Therapy, PC
• Paul Jerrel G. Jose
• Kim & Nam LLC
• Giyoung Kim, PHARMD
• Stephan Nicholas Koleff Sr., D.C.
• Margarita L Kotsogiannis, RPH
• Boo Ja Lee
• Young Ho Lee, M.S.
• Michael Peter Logothetis, RPH

• General Practice Dentistry in Carlstadt, NJ
• Providers in Carlstadt, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2019; 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.