Phil Joe Kim, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

19866 Issued in TX

Practice address

4865 Hedgcoxe Rd.
Ste. 300
Plano, TX 75024

Phone

(972) 505-2210

Fax

(972) 505-2212

NPI assigned

Dec 16, 2005

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

Medicare fee-for-service enrollment

Enrolled in TX

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

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

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513209600000",
    "number": "1720064132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4865 HEDGCOXE RD.",
            "address_2": "STE. 300",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "75024",
            "telephone_number": "972-505-2210",
            "fax_number": "972-505-2212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4865 HEDGCOXE RD.",
            "address_2": "STE. 300",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "75024",
            "telephone_number": "972-505-2210",
            "fax_number": "972-505-2212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "PHIL",
        "middle_name": "JOE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-16",
        "last_updated": "2017-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "19866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Carroll Kim, MD
• Jeff Kim
• Kara Hwakyong Kim, D.D.S.
• Kristin Joo Eun Kim, FNP-C
• Nancy Y Kim, M.D.
• Ryomin Kim, MD
• Soo Kim, R.D. L.D.
• Sung H Kim, DDS
• Suzanne Kim
• Edna Kimanga, NP

• Oral and Maxillofacial Surgery (Dentist) in Plano, TX
• Providers in Plano, TX by specialty
• Oral and Maxillofacial Surgery (Dentist) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2017; 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.