Individual provider Active NPI

Sol Kim, DMD

  • Dentist
  • Apollo Beach, FL
National Provider Identifier
1700432911
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN28374 Issued in FL
Practice address
6182 N US Highway 41 Unit a
Apollo Beach, FL 33572-1805
Phone
(813) 771-0329
NPI assigned
Aug 13, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 00204135 CO
Dentist 122300000X DN28374 FL Primary

Addresses

Primary practice location

6182 N US Highway 41 Unit a
Apollo Beach, FL 33572-1805

Mailing address

6182 N US Highway 41 Unit a
Apollo Beach, FL 33572-1805

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20240509000690 FL Order and Referring Only - DentistPractitioner - Dentist 3779924659

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
00204135COMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Apollo Beach Modern Dentistry, PA CurrentSince Jul 16, 2023 Accepting new patients

Locations

6182 N US Highway 41
Unit A
Apollo Beach, FL 33572
Phone (813) 771-0329

Networks

  • Freedom Health HMO Network

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.

NPI Registry JSON

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

{
    "created_epoch": "1565654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1700432911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6182 N US HIGHWAY 41 UNIT A",
            "city": "APOLLO BEACH",
            "state": "FL",
            "postal_code": "335721805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6182 N US HIGHWAY 41 UNIT A",
            "city": "APOLLO BEACH",
            "state": "FL",
            "postal_code": "335721805",
            "telephone_number": "813-771-0329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SOL",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-13",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "00204135",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN28374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Apollo Beach, FL

Sources for this page

Verify at the official NPI Registry.