Active NPI
Brandon Jaeyoon Shim, DDS
- General Practice Dentistry
- Newark, NJ
National Provider Identifier
1841020021
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 22DI03052500
- Practice address
- 539 Bloomfield Ave Ste 3
Newark, NJ 07107-1385 - Phone
- (973) 604-1600
- NPI assigned
- Aug 3, 2024
- 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 | 22DI03052500 | NJ | Primary |
Addresses
Primary practice location
539 Bloomfield Ave Ste 3
Newark, NJ 07107-1385
Mailing address
539 Bloomfield Ave Ste 3
Newark, NJ 07107-1385
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI03052500 | NJ | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nova Dental Associates PC | General Practice | Current | Accepting new patients |
Locations
539 Bloomfield Ave
Ste 3
Newark, NJ 07107
Phone (973) 604-1600
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": "1722643200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722643200000",
"number": "1841020021",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "539 BLOOMFIELD AVE STE 3",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071071385"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "539 BLOOMFIELD AVE STE 3",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071071385",
"telephone_number": "973-604-1600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIM",
"first_name": "BRANDON",
"middle_name": "JAEYOON",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-08-03",
"last_updated": "2024-08-03",
"certification_date": "2024-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NJ",
"license": "22DI03052500",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.