Active NPI
Jenny Kim, DDS
- Dentist
- Madison, WI
National Provider Identifier
1861232712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6001502
- Practice address
- 3434 E Washington Ave
Madison, WI 53704-4155 - Phone
- (608) 443-5482
- NPI assigned
- May 29, 2024
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 6001502 | WI | Primary |
Addresses
Primary practice location
3434 E Washington Ave
Madison, WI 53704-4155
Mailing address
7974 Uw Health CT
Middleton, WI 53562-5531
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- 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 |
|---|---|---|---|---|
| I20240626001196 | WI | Order and Referring Only - Dentist | 1850835315 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6001502 | WI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716940800000",
"number": "1861232712",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7974 UW HEALTH CT",
"city": "MIDDLETON",
"state": "WI",
"postal_code": "535625531"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3434 E WASHINGTON AVE",
"city": "MADISON",
"state": "WI",
"postal_code": "537044155",
"telephone_number": "608-443-5482"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JENNY",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-05-29",
"last_updated": "2024-05-29",
"certification_date": "2024-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "6001502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2024; 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.