Charlie Kim, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

101473 Issued in CA

Practice address

Camp Humphreys
Carius Dental Clinic BLDG 3020
Apo, AP 96271

Phone

(050) 737-3368

NPI assigned

Jun 28, 2017

Last updated

Sep 12, 2018By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Martin Army Community Hospital

  dba Usadc Ft. Benning Love

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • Fort Benning, GA
  • NPI 1174726640
  NPD (past)

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

{
    "created_epoch": "1498608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536710400000",
    "number": "1871014902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "MIL",
            "address_1": "CAMP HUMPHREYS",
            "address_2": "CARIUS DENTAL CLINIC BLDG 3020",
            "city": "APO",
            "state": "AP",
            "postal_code": "96271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "MIL",
            "address_1": "CAMP HUMPHREYS",
            "address_2": "CARIUS DENTAL CLINIC BLDG 3020",
            "city": "APO",
            "state": "AP",
            "postal_code": "96271",
            "telephone_number": "050-737-3368"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7101 Hoff St Bldg 9240",
            "address_purpose": "LOCATION",
            "city": "Fort Benning",
            "state": "GA",
            "postal_code": "319055645",
            "country_code": "US",
            "telephone_number": "706-544-2051",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "CHARLIE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-28",
        "last_updated": "2018-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "101473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.