Active NPI
Gyeongwon Kim
- Oral and Maxillofacial Surgery (Dentist)
- Cockeysville, MD
National Provider Identifier
1669030391
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 17951
- Practice address
- 10 Warren Rd Ste 330
Cockeysville, MD 21030-2535 - Phone
- (410) 666-5225
- NPI assigned
- May 29, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 17951 | MD | Primary |
Addresses
Primary practice location
10 Warren Rd Ste 330
Cockeysville, MD 21030-2535
Mailing address
1565 Lowman St
Baltimore, MD 21230-5609
Phone (970) 685-9673
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 4, 2023 through Oct 4, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17951 | MD | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709683200000",
"number": "1669030391",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1565 LOWMAN ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212305609",
"telephone_number": "970-685-9673"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 WARREN RD STE 330",
"city": "COCKEYSVILLE",
"state": "MD",
"postal_code": "210302535",
"telephone_number": "410-666-5225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "GYEONGWON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-29",
"last_updated": "2024-03-06",
"certification_date": "2024-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "MD",
"license": "17951",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cockeysville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.