Dongwook Kim, DDS
Individual provider Active NPI General Practice Dentistry · Leonia, NJ
NPI 1760586192 · NPPES record last updated Apr 21, 2020
Key facts
- NPI
- 1760586192
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DI20263 (NJ)
- Practice address
- 384 Broad Ave
Leonia, NJ 07605-1701 - Phone
- (201) 363-9890
- Fax
- (201) 363-9897
- NPI assigned
- Sep 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160503001635 | NJ | Order and Referring Only - Oral Surgery |
0042519613 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DI20263 | NJ | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bergen Implant Center PA | Current |
Accepting new patients |
Locations
384 Broad Ave
Leonia, NJ 07605
Phone (201) 363-9890
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DI20263 | NJ | Yes |
Addresses
Primary practice location
384 Broad Ave
Leonia, NJ 07605-1701
Mailing address
341 Broad Ave
Leonia, NJ 07605-1701
Phone (201) 363-9890
Other names
- Dr. Steve Kim
Other providers in Leonia, NJ
- Jacqueline Juele-Schuster
- Juli Kang
- Ilana Kanovsky
- Jasmine Kaur
- David Suksoo Kim
- Eun Lee Kim
- Minjung Kim
- Sera Kim
- Yeong C Kim
- Yun Yong Kim
All providers in Leonia, NJ · General Practice Dentistry in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.