Jay Kim, DMD
Individual provider Active NPI General Practice Dentistry · Agana Heights, GU
NPI 1699440347 · NPPES record last updated Sep 19, 2023
Key facts
- NPI
- 1699440347
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 0401417592 (VA)
- Practice address
- U.S. Naval Hospital Guam
BLDG 50, Farenholt Ave
Agana Heights, GU 96910 - Phone
- (671) 344-9340
- NPI assigned
- Aug 14, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210820001962 | VA | Order and Referring Only - Dentist |
7810392388 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 0401417592 | VA | Yes |
Addresses
Primary practice location
U.S. Naval Hospital Guam
BLDG 50, Farenholt Ave
Agana Heights, GU 96910
Mailing address
PSC 455 Box 208
Fpo, AP 96540-0003
Phone (671) 344-9340
Other providers in Agana Heights, GU
- Laura Infante
- Damon Ty Jensen
- Henry Tait Keenan
- Grace Agnes Kennedy
- Patrick Robert Kennedy
- Sean S Kim
- Jacob Ryan King
- Brianna Nicole Koes
- Amanda Louise Kundrat
- June Aiko Larkin
All providers in Agana Heights, GU · General Practice Dentistry in Guam
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.