Roderick Youngdo Kim, DDS, MD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

32838 Issued in TX

Practice address

1500 S Main St Dept of
Fort Worth, TX 76104-4917

Phone

(817) 702-6936

NPI assigned

Aug 23, 2011

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

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Maxillofacial Surgery

Education

University of Michigan Medical School, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oral and Maxillofacial Network PLLCGroup PAC ID 2668498387, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• JPS Health Network Hospital, Fort Worth, TX, CCN 450039

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Oral & Maxillofacial Network, P.L.L.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Fort Worth, TX
  • NPI 1417170655
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Tarrant County Hospital District

  • General Acute Care Hospital
  • Fort Worth, TX
  • NPI 1992753222
  Care Compare affiliation

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

{
    "created_epoch": "1314057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719360000000",
    "number": "1689954562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 SOUTH MAIN",
            "address_2": "DEPARTMENT OF OMFS",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S MAIN ST DEPT OF",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044917",
            "telephone_number": "817-702-6936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "RODERICK",
        "middle_name": "YOUNGDO",
        "credential": "DDS, MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-23",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "TX",
            "license": "32838",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "32838",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaehee Kim
• Jeong Kim, NP
• Jiyeon Kim
• Joyce Kim, MD
• Peter S Kim, M.D.
• Sarah Kim, DDS, MPH, CPH
• Sarah Kim
• Sasha Kim
• Stephen Joowhan Kim, M.D.
• Stephen S Kim, PHARM.D.

• Oral & Maxillofacial Surgery (D.M.D.) in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.