Shanna Kyungmi Kim, DDS

Primary specialty

Orofacial Pain DentistryTaxonomy code 1223X2210X

License

7344 Issued in NV

Practice address

4840 Vista Blvd Ste 108
Sparks, NV 89436-2850

Phone

(775) 362-9374

NPI assigned

Jan 14, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jun 12, 2025 through Jun 12, 2027

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: shanna.kim.1@32240.direct.athenahealth.com

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

{
    "created_epoch": "1294963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732752000000",
    "number": "1710282272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17128",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895113101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4840 VISTA BLVD STE 108",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894362850",
            "telephone_number": "775-362-9374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SHANNA",
        "middle_name": "KYUNGMI",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-01-14",
        "last_updated": "2024-11-28",
        "certification_date": "2024-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X2210X",
            "taxonomy_group": "",
            "desc": "Dentist, Orofacial Pain",
            "state": "NV",
            "license": "7344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cory WM Kilgallen, PHARMD.
• James V Kilgore
• Veronica Kilgore
• Ircia Meredith Kille, BCBA
• Nicole Ladnier Killian, PA
• James W Kimbriel, DC
• Brandi M Kindig, MD
• Carla King
• Kelly Ann King, MD
• Kirstin King, RN

• Orofacial Pain Dentistry in Sparks, NV
• Providers in Sparks, NV by specialty
• Orofacial Pain Dentistry in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.