Michael Hansoo Kim, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

0401413573 Issued in VA

Practice address

21001 Sycolin Rd
Suite 240
Ashburn, VA 20147-4073

Phone

(703) 723-4224

NPI assigned

Jul 28, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Goose Creek Village Dental

  • Dental Clinic/Center
  • Ashburn, VA
  • NPI 1902207327
  NPD (past) Authorized official

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409184000000",
    "number": "1659385367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21001 SYCOLIN RD",
            "address_2": "SUITE 240",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201474073",
            "telephone_number": "703-723-4224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21001 SYCOLIN RD",
            "address_2": "SUITE 240",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201474073",
            "telephone_number": "703-723-4224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MICHAEL",
        "middle_name": "HANSOO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2014-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901018597",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401413573",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4631948",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4631957",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diana Kiessieh
• Cindy H Kim, MD
• Daniel Kim
• Eunice Kim
• Hye Sung Kim, L.AC
• Suhad Kim, DDS
• Deborah Lee Kimball, MA, CAS
• Teri Ann Kimball, M.A.
• Kind Angels Homecare Services LLC
• Karen Kingsley, PH.D.

• All providers in Ashburn, VA
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2014; 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.