Active NPI
Soo-Woo Kim, D.M.D., D.M.SC. M.S.
- Dentist
- Boston, MA
National Provider Identifier
1710134812
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 22306
- Practice address
- 188 Longwood Ave
Boston, MA 02115-5819 - Phone
- (617) 432-1434
- NPI assigned
- Aug 20, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 22306 | MA | Primary |
| Periodontics | 1223P0300X | DN22306 | MA |
Addresses
Primary practice location
188 Longwood Ave
Boston, MA 02115-5819
Mailing address
55 June LN
Newton, MA 02459-3611
Phone (617) 309-9701
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160706000958 | MA | Order and Referring Only - Dentist | 6305138751 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22306 | MA | MD | Dentist |
Interoperability endpoints
- skim30151@direct.bostonchildrens.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464566400000",
"number": "1710134812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 JUNE LN",
"city": "NEWTON",
"state": "MA",
"postal_code": "024593611",
"telephone_number": "617-309-9701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "188 LONGWOOD AVE",
"city": "BOSTON",
"state": "MA",
"postal_code": "021155819",
"telephone_number": "617-432-1434"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SOO-WOO",
"name_prefix": "Dr.",
"credential": "D.M.D., D.M.SC. M.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-08-20",
"last_updated": "2016-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "22306",
"primary": true
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MA",
"license": "DN22306",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2016; 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.