Samuel Kim, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

DDS-09114 Issued in IA

Practice address

3722 Cedar Heights Dr
Cedar Falls, IA 50613-6207

Phone

(319) 266-7559

NPI assigned

Jul 31, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IA

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

Practice roles

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.

• Everbreeze Dental LLC

  • Dental Clinic/Center
  • Madison, WI
  • NPI 1164355061
  NPD Authorized official
• Cedar Valley Dental Associates PC

  • General Practice Dentistry
  • Parkersburg, IA
  • NPI 1376103390
  NPD (past)
• Cedar Valley Dental Associates PC

  • General Practice Dentistry
  • Cedar Falls, IA
  • NPI 1699981233
  NPD (past)

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

{
    "created_epoch": "1406764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557100800000",
    "number": "1740698992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3722 CEDAR HEIGHTS DR",
            "city": "CEDAR FALLS",
            "state": "IA",
            "postal_code": "506136207",
            "telephone_number": "319-266-7559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3722 CEDAR HEIGHTS DR",
            "city": "CEDAR FALLS",
            "state": "IA",
            "postal_code": "506136207",
            "telephone_number": "319-266-7559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-31",
        "last_updated": "2019-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "1000974-15",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IA",
            "license": "DDS-09114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122300000X",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melody K Kern, ARNP
• Taylor Joseph Kettman, DPT
• Morgan Kidder
• Andrew Kikuta, MD
• Howard T Kim, MD
• Kimball and Beecher PLLC
• Shufei Kime, D.C.
• Alatheia Rae King, PHARMD
• Emilina King, LISW
• Sharon K. King, P.T

• Dentist in Cedar Falls, IA
• Providers in Cedar Falls, IA by specialty
• Dentist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2019; 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.