Kevin Minsung Kim, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DE61034697 Issued in WA

Practice address

1717 Olympia Way
Longview, WA 98632-3929

Phone

(360) 636-1900

NPI assigned

May 26, 2018

Last updated

Jul 22, 2020By 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 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pediatric Dental Associates PLLC

  • Pediatric Dentistry
  • Williamsville, NY
  • NPI 1144730649

  General Practice

  NPD (past)
• University Pediatric Dentistry, P.C.

  • Pediatric Dentistry
  • Buffalo, NY
  • NPI 1649389560
  NPD (past)

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

{
    "created_epoch": "1527292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595376000000",
    "number": "1831680750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 OLYMPIA WAY",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323929",
            "telephone_number": "360-636-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 OLYMPIA WAY",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323929",
            "telephone_number": "360-636-1900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Main St",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "NY",
            "postal_code": "142092308",
            "country_code": "US",
            "telephone_number": "716-242-8200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "114 Squire Hall",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "NY",
            "postal_code": "142148006",
            "country_code": "US",
            "telephone_number": "716-829-3717",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "KEVIN",
        "middle_name": "MINSUNG",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-26",
        "last_updated": "2020-07-22",
        "certification_date": "2020-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE61034697",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "DE61034697",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE61034697",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Sanghyun Kim
• Helen H Kim, MD
• Hyun Ji Kim
• Hyun Joong Kim, DO
• John Y Kim, DO
• Jamie R Kincaid, BA, AAC
• Autumn Kindvall
• Katana Beth King, ND
• Katie King
• Michelle Myrle Kinney, CPC

• Pediatric Dentistry in Longview, WA
• Providers in Longview, WA by specialty
• Pediatric Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2020; 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.