Active NPI
Tong Wook Kim, DDS
- General Practice Dentistry
- Fort Worth, TX
National Provider Identifier
1689292294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 39316
- Practice address
- 4160 Heritage Trace Pkwy
Fort Worth, TX 76244-5312 - Phone
- (817) 741-4288
- NPI assigned
- Jul 9, 2020
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 39316 | TX | Primary |
Addresses
Primary practice location
4160 Heritage Trace Pkwy
Fort Worth, TX 76244-5312
Mailing address
1209 Daylily Dr
Argyle, TX 76226-3209
Phone (804) 955-8484
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 |
|---|---|---|---|
| 39316 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712534400000",
"number": "1689292294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1209 DAYLILY DR",
"city": "ARGYLE",
"state": "TX",
"postal_code": "762263209",
"telephone_number": "804-955-8484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4160 HERITAGE TRACE PKWY",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "762445312",
"telephone_number": "817-741-4288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "TONG",
"middle_name": "WOOK",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-07-09",
"last_updated": "2024-04-08",
"certification_date": "2024-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "39316",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 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.