Active NPI
Hak Kyun Kim, DDS
- Dentist
- Berkeley, CA
National Provider Identifier
1821583048
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DDS102604
- Practice address
- 115 Berkeley SQ
Berkeley, CA 94704-1206 - Phone
- (510) 982-0300
- NPI assigned
- Jun 29, 2018
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DDS102604 | CA | Primary |
Addresses
Primary practice location
115 Berkeley SQ
Berkeley, CA 94704-1206
Mailing address
115 Berkeley SQ
Berkeley, CA 94704-1206
Phone (510) 982-0300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS102604 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Neelagiri Dental Group Inc | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642464000000",
"number": "1821583048",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 BERKELEY SQ",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947041206",
"telephone_number": "510-982-0300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 BERKELEY SQ",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947041206",
"telephone_number": "510-982-0300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "HAK KYUN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-29",
"last_updated": "2022-01-18",
"certification_date": "2022-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "DDS102604",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2022; 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.