Active NPI
Jihwan Kim
- Pediatric Dentistry
- Austin, TX
National Provider Identifier
1851970073
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 39386
- Practice address
- 5900 W Slaughter LN Ste 470C
Austin, TX 78749-6513 - Phone
- (512) 948-3822
- NPI assigned
- Apr 5, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 39386 | TX | |
| Pediatric Dentistry | 1223P0221X | 39386 | TX | Primary |
Addresses
Primary practice location
5900 W Slaughter LN Ste 470C
Austin, TX 78749-6513
Mailing address
8400 Evelina TRL
Austin, TX 78737-8546
Phone (917) 886-4556
Other practice location 1
2440 E Highway 290 Ste B
Dripping Springs, TX 78620-5485
Phone (512) 858-0232
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- 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 |
|---|---|---|---|---|
| I20240730001996 | TX | Order and Referring Only - Dentist | 4486191244 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39386 | TX | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688515200000",
"number": "1851970073",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8400 EVELINA TRL",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787378546",
"telephone_number": "917-886-4556"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5900 W SLAUGHTER LN STE 470C",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787496513",
"telephone_number": "512-948-3822"
}
],
"practiceLocations": [
{
"address_1": "2440 E Highway 290 Ste B",
"address_purpose": "LOCATION",
"city": "Dripping Springs",
"state": "TX",
"postal_code": "786205485",
"country_code": "US",
"telephone_number": "512-858-0232",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIM",
"first_name": "JIHWAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-04-05",
"last_updated": "2023-07-05",
"certification_date": "2023-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "39386",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "TX",
"license": "39386",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; 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.