Active NPI
Peter Eusuk Kim, DMD
- General Practice Dentistry
- El Paso, TX
National Provider Identifier
1821475369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 30827
- Practice address
- 4649 Loma del Sur Dr
Apt 3307
El Paso, TX 79934-3350 - Phone
- (216) 526-2174
- NPI assigned
- May 5, 2015
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 30827 | TX | Primary |
Addresses
Primary practice location
4649 Loma del Sur Dr
Apt 3307
El Paso, TX 79934-3350
Mailing address
5340 El Paso Dr
Suite K
El Paso, TX 79905-2837
Phone (915) 781-7725
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160128001364 | TX | Order and Referring Only - Dentist | 7810290681 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430784000000",
"number": "1821475369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5340 EL PASO DR",
"address_2": "SUITE K",
"city": "EL PASO",
"state": "TX",
"postal_code": "799052837",
"telephone_number": "915-781-7725",
"fax_number": "915-779-3387"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4649 LOMA DEL SUR DR",
"address_2": "APT 3307",
"city": "EL PASO",
"state": "TX",
"postal_code": "799343350",
"telephone_number": "216-526-2174"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "PETER",
"middle_name": "EUSUK",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-05-05",
"last_updated": "2015-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "30827",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Paso, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.