Active NPI
Hyeong Chan Kim, D.D.S., PH.D.
- General Practice Dentistry
- Elmhurst, NY
National Provider Identifier
1841501442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 055881
- Practice address
- 4238 79TH St
Elmhurst, NY 11373-3057 - Phone
- (917) 602-7420
- NPI assigned
- Jun 29, 2010
- Sex
- Male
- Sole proprietor
- Yes
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 | 055881 | NY | Primary |
Addresses
Primary practice location
4238 79TH St
Elmhurst, NY 11373-3057
Mailing address
4238 79TH St
Elmhurst, NY 11373-3057
Phone (917) 602-7420
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161221000114 | NY | Order and Referring Only - Dentist | 9739460239 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 055881 | NY | MD | Pharmacotherapy Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342742400000",
"number": "1841501442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4238 79TH ST",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113733057",
"telephone_number": "917-602-7420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4238 79TH ST",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113733057",
"telephone_number": "917-602-7420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "HYEONG",
"middle_name": "CHAN",
"credential": "D.D.S., PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-06-29",
"last_updated": "2012-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "055881",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elmhurst, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2012; 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.