Active NPI
John Hyo Shyn Kim, DDS
- Dentist
- Manchester, CT
National Provider Identifier
1760568000
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 008598
- Practice address
- 147 East Center St
Manchester, CT 06040 - Phone
- (860) 643-9506
- Fax
- (860) 645-1707
- NPI assigned
- Oct 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 008598 | CT | Primary |
Addresses
Primary practice location
147 East Center St
Manchester, CT 06040
Mailing address
14 Cross Creek Dr
Berlin, CT 06037
Phone (860) 259-5161
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151027002043 | CT | Order and Referring Only - Other (Non-Physician) | 3476862707 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 008598 | CT | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162166400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760568000",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 CROSS CREEK DR",
"city": "BERLIN",
"state": "CT",
"postal_code": "06037",
"telephone_number": "860-259-5161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "147 EAST CENTER ST",
"city": "MANCHESTER",
"state": "CT",
"postal_code": "06040",
"telephone_number": "860-643-9506",
"fax_number": "860-645-1707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JOHN",
"middle_name": "HYO SHYN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CT",
"license": "008598",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manchester, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.