John Kim

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

65365 Issued in CA

Practice address

1080 Jones St Apt 411
Berkeley, CA 94710-1559

Phone

(626) 644-3614

NPI assigned

Jan 18, 2016

Last updated

Jul 6, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: jkim596676@direct.ochin.org

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

{
    "created_epoch": "1453075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657065600000",
    "number": "1831556117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1080 JONES ST APT 411",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947101559",
            "telephone_number": "626-644-3614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1080 JONES ST APT 411",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947101559",
            "telephone_number": "626-644-3614"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10011 Bridgeport Way SW",
            "address_2": "Ste 700",
            "address_purpose": "LOCATION",
            "city": "Lakewood",
            "state": "WA",
            "postal_code": "984992332",
            "country_code": "US",
            "telephone_number": "253-215-1101",
            "fax_number": "253-617-0695",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "JOHN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-01-18",
        "last_updated": "2022-07-06",
        "certification_date": "2022-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60678182",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "65365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Kim
• Haeyin Kim
• Hak Kyun Kim, DDS
• Helen Youngju Kim, MA
• Jennifer Peea Kim, MS, LAC
• Mi Hyun Kim, DDS
• Seong-Hee Kim
• Soo Jung Kim
• Tae Sun Kim, M.A.
• Vivienne Kim

• General Practice Dentistry in Berkeley, CA
• Providers in Berkeley, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 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.

Verify at the official NPI Registry.