Sung Kwang Kim, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

059693 Issued in NY

Practice address

2740 3Rd Ave
Bronx, NY 10455-4036

Phone

(917) 263-1604

NPI assigned

Aug 15, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Third Avenue Bronx Dental PC

  • Dental Clinic/Center
  • Bronx, NY
  • NPI 1720542210
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1376524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547596800000",
    "number": "1699108563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2740 3RD AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104554036",
            "telephone_number": "718-618-0162",
            "fax_number": "718-618-0173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2740 3RD AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104554036",
            "telephone_number": "917-263-1604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SUNG KWANG",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-08-15",
        "last_updated": "2019-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "059693",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "13867803",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05315619",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Soo G Kim, MD
• Soon Ae Kim
• Sophia Kim, DMD, MS
• Steive Kim, DDS
• Sun Jin Kim, MD
• Sunghyun Kim, DDS
• Susan Kim, MD
• Tyler Kim, MD
• Ye Hum Kim, MD
• Yeaseo Kim

• General Practice Dentistry in Bronx, NY
• Providers in Bronx, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.