Active NPI
Myung David Kim, DMD
- Oral and Maxillofacial Surgery (Dentist)
- Philadelphia, PA
National Provider Identifier
1770660664
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- D028558
- Practice address
- 1335 W Tabor Rd
Suite 307
Philadelphia, PA 19141 - Phone
- (215) 224-7757
- Fax
- (215) 424-8103
- NPI assigned
- Nov 1, 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 |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | D028558 | PA | Primary |
Addresses
Primary practice location
1335 W Tabor Rd
Suite 307
Philadelphia, PA 19141
Mailing address
1335 W Tabor Rd
Suite 307
Philadelphia, PA 19141
Phone (215) 224-7757
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 15, 2026 through Apr 15, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D028558 | PA | MD | Oral and Maxillofacial Surgery (Dentist) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1770660664",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1335 W TABOR RD",
"address_2": "SUITE 307",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19141",
"telephone_number": "215-224-7757",
"fax_number": "215-424-8103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1335 W TABOR RD",
"address_2": "SUITE 307",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19141",
"telephone_number": "215-224-7757",
"fax_number": "215-424-8103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MYUNG",
"middle_name": "DAVID",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "PA",
"license": "D028558",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.