Jennifer Suji Kim, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI02835700 Issued in NJ

Practice address

42 W Allendale Ave
Allendale, NJ 07401-1739

Phone

(201) 760-1116

NPI assigned

May 21, 2020

Reactivated

Aug 20, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 7, 2022 through Feb 7, 2028

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 and National Provider Directory roles.

• Allendale Dental PC

  • General Practice Dentistry
  • Allendale, NJ
  • NPI 1104749324

  General Practice

  NPD (past)
• Luisa Milo DDS LLC

  • Dentist
  • Allendale, NJ
  • NPI 1275620213
  NPD (past)

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

{
    "created_epoch": "1590019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656374400000",
    "number": "1780207993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 ANDERSON AVE APT 7A",
            "city": "CLIFFSIDE PARK",
            "state": "NJ",
            "postal_code": "070102163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 W ALLENDALE AVE",
            "city": "ALLENDALE",
            "state": "NJ",
            "postal_code": "074011739",
            "telephone_number": "201-760-1116"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1775 Grand Concourse",
            "address_2": "BronxCare Health Systems, Dept of Dentistry, 6th floor",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "10453",
            "country_code": "US",
            "telephone_number": "718-901-8410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "JENNIFER",
        "middle_name": "SUJI",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-21",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "deactivation_date": "2021-08-01",
        "reactivation_date": "2021-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02835700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessy John
• Jodi Sue Jones, RN
• Clayton William Judy II, DMD
• Ediltruda N Kalikawe
• Lindsey Kawas, NP
• Ritchie Kim, D.P.T
• KJ Shute Home Care, Inc
• Peter C Koeniges, M. ED., ATC, CSCS
• Lindsay Kokinen, M.S.W., L.C.S.W.
• Kara Nicole Kushnir, LCSW

• All providers in Allendale, NJ
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.