Jean Kim Lau, DDS

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

22DI02794500 Issued in NJ

Practice address

55 Woodland Ave
Summit, NJ 07901-2225

Phone

(908) 224-1701

NPI assigned

Jul 16, 2015

Reactivated

Sep 5, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Dr. Jean Kim Former name

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 25, 2025 through Apr 25, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Prism Oral Surgery & Implants of Summit

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Summit, NJ
  • NPI 1265237069

  Single Specialty

  NPD Authorized official
• Advanced Oral Surgery and Implant Center

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Bethlehem, PA
  • NPI 1104398510

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1437004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749600000000",
    "number": "1730563107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 WOODLAND AVE",
            "city": "SUMMIT",
            "state": "NJ",
            "postal_code": "079012225",
            "telephone_number": "908-224-1707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 WOODLAND AVE",
            "city": "SUMMIT",
            "state": "NJ",
            "postal_code": "079012225",
            "telephone_number": "908-224-1701"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2571 Baglyos Cir Ste B23",
            "address_purpose": "LOCATION",
            "city": "Bethlehem",
            "state": "PA",
            "postal_code": "180208051",
            "country_code": "US",
            "telephone_number": "484-821-1357",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAU",
        "first_name": "JEAN",
        "middle_name": "KIM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-16",
        "last_updated": "2025-06-11",
        "certification_date": "2025-06-11",
        "deactivation_date": "2019-08-01",
        "reactivation_date": "2019-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NY",
            "license": "060486",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "PA",
            "license": "DS042263",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NJ",
            "license": "22DI02794500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEAN",
            "last_name": "KIM",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Chang Kweon, MD
• Yong S Kwon, MD
• Mona Labat, M.D.
• Michelle Robyn Lakefield, LPC
• Bogdan Mark Langner, PA-C
• Laura Woolfson, LLC
• Gloria M. Lax, MD
• Brandon Alexander Cody Lee, MD
• Kiwon Lee, M.D.
• Lauren Lee

• Oral & Maxillofacial Surgery (D.M.D.) in Summit, NJ
• Providers in Summit, NJ by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2025; 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.