Active NPI
Tae Soo Kim, DMD
- General Practice Dentistry
- North Wales, PA
National Provider Identifier
1689748642
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DS036075
- Practice address
- 275 Dekalb Pike Unit 101
North Wales, PA 19454-1807 - Phone
- (215) 699-3700
- Fax
- (215) 699-4700
- NPI assigned
- Nov 20, 2006
- Sex
- Female
- 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 | DS036075 | PA | Primary |
Addresses
Primary practice location
275 Dekalb Pike Unit 101
North Wales, PA 19454-1807
Mailing address
275 Dekalb Pike Unit 101
North Wales, PA 19454-1807
Phone (215) 699-3700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101061282 | Medicaid | PA |
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 |
|---|---|---|---|
| DS036075 | PA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Apple Family Dentistry | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- North Wales, PA
- NPI 1629309182
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457913600000",
"number": "1689748642",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "275 DEKALB PIKE UNIT 101",
"city": "NORTH WALES",
"state": "PA",
"postal_code": "194541807",
"telephone_number": "215-699-3700",
"fax_number": "215-699-4700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "275 DEKALB PIKE UNIT 101",
"city": "NORTH WALES",
"state": "PA",
"postal_code": "194541807",
"telephone_number": "215-699-3700",
"fax_number": "215-699-4700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "TAE",
"middle_name": "SOO",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-20",
"last_updated": "2016-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "PA",
"license": "DS036075",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "101061282",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in North Wales, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.