Active NPI
Pyo Jae Kim
- General Practice Dentistry
- Troy, MI
National Provider Identifier
1659991107
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2901600680
- Practice address
- 805 Sandalwood Dr
Troy, MI 48085-1643 - Phone
- (213) 400-2614
- NPI assigned
- Apr 24, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| General Practice Dentistry | 1223G0001X | 2901600680 | MI | Primary |
Addresses
Primary practice location
805 Sandalwood Dr
Troy, MI 48085-1643
Mailing address
805 Sandalwood Dr
Troy, MI 48085-1643
Phone (213) 400-2614
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 |
|---|---|---|---|
| 2901600680 | MI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1587686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611014400000",
"number": "1659991107",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "805 SANDALWOOD DR",
"city": "TROY",
"state": "MI",
"postal_code": "480851643",
"telephone_number": "213-400-2614"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "805 SANDALWOOD DR",
"city": "TROY",
"state": "MI",
"postal_code": "480851643",
"telephone_number": "213-400-2614"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "PYO JAE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-04-24",
"last_updated": "2021-01-19",
"certification_date": "2021-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MI",
"license": "2901600680",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Troy, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.