Peter Geuntae Kim, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

047152 Issued in NY

Practice address

4719 Bell Blvd
Bayside, NY 11361-3333

Phone

(718) 224-5576

Fax

(718) 224-5587

NPI assigned

Jul 19, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Geuntae Kim Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811916877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 KATHLEEN DR",
            "city": "SYOSSET",
            "state": "NY",
            "postal_code": "117915808",
            "telephone_number": "516-993-9691",
            "fax_number": "718-224-5587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4719 BELL BLVD",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113613333",
            "telephone_number": "718-224-5576",
            "fax_number": "718-224-5587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "PETER",
        "middle_name": "GEUNTAE",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "047152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02512985",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GEUNTAE",
            "last_name": "KIM",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kyung Il Kim, DDS
• Min Jung Kim
• Myoungmi Kim
• Myung Sook Kim, MDPP
• Namwu Kim
• Regina Kim
• Sara Soonsik Kim, MPH
• Seong-Hee Kim
• Sonya Kim, PHARMD
• Soo Yeon Kim

• General Practice Dentistry in Bayside, NY
• Providers in Bayside, NY by specialty
• General Practice Dentistry in New York

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.