Inkyu Kim, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

30.27195 Issued in OH

Practice address

6145 Desert Storm Ave
Fort Campbell, KY 42223-5558

Phone

(216) 644-6346

NPI assigned

Jul 11, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Isaac Kim Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1689033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714089600000",
    "number": "1669151304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 TINY TOWN RD APT 14B",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370420122",
            "telephone_number": "216-644-6346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6145 DESERT STORM AVE",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235558",
            "telephone_number": "216-644-6346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "INKYU",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-07-11",
        "last_updated": "2024-04-26",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.27195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ISAAC",
            "last_name": "KIM",
            "credential": "DMD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Julie T Kerr, M.D.
• Sonia Kessler, RN, BSN
• Vincent Durrell Key, LCSW
• Mumtaz Khan, PA
• Leslie Kidd
• Sunyoung Oh Kim, MD
• Martha J King, LPN
• Anna Kirby, PHARM.D.
• Teara Lynn Kist, CRNA
• Harrison J. Klerk, DMD

• Dentist in Fort Campbell, KY
• Providers in Fort Campbell, KY by specialty
• Dentist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2024; 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.