NPIMap

Organization Active NPI

Seong W. Kim, DMD, LLC

  • General Practice Dentistry
  • Portland, OR
National Provider Identifier
1811303241
Registry record updated Jul 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D9495 Issued in OR
Legal business name
SEONG W. KIM, DMD, LLC
Doing business as
PEACHTREE DENTAL
Practice address
13056 SE Division St
Portland, OR 97236-3039
Phone
(503) 760-1341
NPI assigned
Jul 7, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2014

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

Authorized official

Name
Seong KimNPI 1710296660
Title
Owner
Phone
(503) 473-4839

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D9495 OR Primary

Addresses

Primary practice location

13056 SE Division St
Portland, OR 97236-3039

Mailing address

13056 SE Division St
Portland, OR 97236-3039

Other names 1

  • PEACHTREE DENTAL Doing business as

National Provider Directory

National Provider Directory

Locations

13056 SE Division St
Portland, OR 97236
Phone (503) 760-1341

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1404691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404691200000",
    "number": "1811303241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13056 SE DIVISION ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972363039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13056 SE DIVISION ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972363039",
            "telephone_number": "503-760-1341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEONG W. KIM, DMD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-07",
        "last_updated": "2014-07-07",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "SEONG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-473-4839"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PEACHTREE DENTAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.