Third Avenue Bronx Dental PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

THIRD AVENUE BRONX DENTAL PC

Practice address

2740 3Rd Ave
Bronx, NY 10455-4036

Phone

(718) 618-0162

Fax

(718) 618-0173

NPI assigned

Jan 29, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Sung Kwang Kim, DDSNPI 1699108563

Title

Owner

Phone

(718) 618-0162

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sung Kwang Kim, D.D.S.

  • General Practice Dentistry
  • Bronx, NY
  • NPI 1699108563
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1548720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548720000000",
    "number": "1720542210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2740 3RD AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104554036",
            "telephone_number": "718-618-0162",
            "fax_number": "718-618-0173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2740 3RD AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104554036",
            "telephone_number": "718-618-0162",
            "fax_number": "718-618-0173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRD AVENUE BRONX DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-29",
        "last_updated": "2019-01-29",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "SUNG KWANG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-618-0162",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05315619",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chamundeeswari Thiageswaran, MA CCC-SLP TSSH
• Gina Thibodeaux, AGNP
• Jeremy Thies
• Namratha Thikkavarapu, PT
• Tenzin Thinley
• Third Avenue Dental P.C.
• Third Avenue Imaging LLC
• Third Avenue Open MRI
• Third Avenue Open MRI, Inc
• Third Avenue Radiology & Imaging PC

• Dental Clinic/Center in Bronx, NY
• Providers in Bronx, NY by specialty
• Dental Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.