Joon Hyuk Kim

Primary specialty

DentistTaxonomy code 122300000X

License

1002240 Issued in WI

Practice address

6100 Washington Ave Ste F2
Mount Pleasant, WI 53406-4000

Phone

(262) 999-9998

NPI assigned

Feb 4, 2020

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

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.

• Familia Dental Green Bay East LLC

  • Dental Clinic/Center
  • Green Bay, WI
  • NPI 1194188706
  NPD (past)

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

{
    "created_epoch": "1580774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702857600000",
    "number": "1740812197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 WASHINGTON AVE STE F2",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534064000",
            "telephone_number": "262-999-9998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6100 WASHINGTON AVE STE F2",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534064000",
            "telephone_number": "262-999-9998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JOON HYUK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-02-04",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "1002240",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100097107",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• KC Jennifer Ketzer, PTA
• Omid Khaksarfard
• Osman Mir Khan, DMD
• Rhodora Khan, APNP
• Beth Kielas, RDN
• Shin-Ye Kim, M.A
• Walter J Kim, M.D.
• Andrews King, NO. 16927 - 130
• Karen M Kleba, RN
• Caroline Schauer Klinker, PT, DPT

• Dentist in Mount Pleasant, WI
• Providers in Mount Pleasant, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2023; 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.