Active NPI
Mijin Kim, DDS
- General Practice Dentistry
- Albany, NY
National Provider Identifier
1801808886
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 000042
- Practice address
- 920 Lark Dr
Albany, NY 12207-1300 - Phone
- (518) 465-4771
- Fax
- (518) 242-4784
- NPI assigned
- Aug 11, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 000042 | NY | Primary |
Addresses
Primary practice location
920 Lark Dr
Albany, NY 12207-1300
Mailing address
920 Lark Dr
Albany, NY 12207-1300
Phone (518) 465-4771
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 |
|---|---|---|---|
| 000042 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1801808886",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "920 LARK DR",
"city": "ALBANY",
"state": "NY",
"postal_code": "122071300",
"telephone_number": "518-465-4771",
"fax_number": "518-242-4784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "920 LARK DR",
"city": "ALBANY",
"state": "NY",
"postal_code": "122071300",
"telephone_number": "518-465-4771",
"fax_number": "518-242-4784"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MIJIN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-11",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "000042",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albany, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.