Active NPI
Daewoong Kim, DDS
- Dentist
- Brooklyn, NY
National Provider Identifier
1801543293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 063736
- Practice address
- 1 Brookdale PLZ # 154
Brooklyn, NY 11212-3198 - Phone
- (718) 240-5000
- NPI assigned
- Mar 4, 2022
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12389 | CT | |
| Dentist | 122300000X | 063736 | NY | Primary |
Addresses
Primary practice location
1 Brookdale PLZ # 154
Brooklyn, NY 11212-3198
Mailing address
427 Eonjuro
Apt 1606
Seoul, NOT APPLICABLE 06221
KR
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 063736 | NY | MD | Dentist |
| 12389 | CT | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646352000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749254400000",
"number": "1801543293",
"addresses": [
{
"country_code": "KR",
"country_name": "Korea, Republic of",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "427 EONJURO",
"address_2": "APT 1606",
"city": "SEOUL",
"state": "NOT APPLICABLE",
"postal_code": "06221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BROOKDALE PLZ # 154",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112123198",
"telephone_number": "718-240-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "DAEWOONG",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-03-04",
"last_updated": "2025-06-07",
"certification_date": "2025-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CT",
"license": "12389",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "063736",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 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.