Jiho Kim

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

40064 Issued in TX

Practice address

3000 Chisholm Trail Rd Unit 61
Round Rock, TX 78681-1998

Phone

(319) 213-8505

NPI assigned

Aug 5, 2020

Last updated

Feb 4, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Familia Dental Madison East LLC

  • Dental Clinic/Center
  • Madison, WI
  • NPI 1821451428

  General Practice

  NPD (past)

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

{
    "created_epoch": "1596585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738627200000",
    "number": "1740890714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 CHISHOLM TRAIL RD UNIT 61",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786811998",
            "telephone_number": "319-213-8505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 CHISHOLM TRAIL RD UNIT 61",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786811998",
            "telephone_number": "319-213-8505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JIHO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-05",
        "last_updated": "2025-02-04",
        "certification_date": "2025-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1002391",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "40064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Khuong, CAA
• Nancy N Kidd, RNFA
• Kids First Pediatric Dentistry
• Heidi C Kiehl, R.D.
• Carl In Kim, M.D.
• Michael Kim, MD
• Min Kim
• Sunmi Kim, COTA
• Kevin Kimbell, CPO
• Kimberly Wills Coates M.D.

• General Practice Dentistry in Round Rock, TX
• Providers in Round Rock, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.