Min Jung Kim, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN20265 Issued in MA

Practice address

340 Maple Street
#210
Marlborough, MA 01752

Phone

(508) 480-9299

Fax

(508) 480-9979

NPI assigned

Nov 15, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Minjung Yoon Former name

Medicare fee-for-service enrollment

Enrolled in MA

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

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.

• Wallis Dental LLC

  • Dental Clinic/Center
  • Lexington, MA
  • NPI 1831867985
  NPD Authorized official
• Minjung Yoon DMD PC

  • General Practice Dentistry
  • Marlborough, MA
  • NPI 1174794986
  NPD (past)

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414627200000",
    "number": "1659444099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 MAPLE STREET",
            "address_2": "#210",
            "city": "MARLBOROUGH",
            "state": "MA",
            "postal_code": "01752",
            "telephone_number": "508-480-9299",
            "fax_number": "508-480-9979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 MAPLE STREET",
            "address_2": "#210",
            "city": "MARLBOROUGH",
            "state": "MA",
            "postal_code": "01752",
            "telephone_number": "508-480-9299",
            "fax_number": "508-480-9979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MIN JUNG",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2014-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN20265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9763210",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MINJUNG",
            "last_name": "YOON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kelsea Kidney
• Sneha Kilari, M.D.
• Sermin Merve Kilicaslan
• Allis Kim, M.D.
• Jenny Kim, DMD
• Ashley King
• Julianna Frances Kinslow
• Biankah Kiser-Miranda
• Michael Roberts Kitz, LCSW, SAC
• Sabrina R Kleber

• General Practice Dentistry in Marlborough, MA
• Providers in Marlborough, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2014; 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.