NPIMap

Organization Active NPI

Ji in Kim, D.D.S., Professional Corporation

  • General Practice Dentistry
  • North Las Vegas, NV
National Provider Identifier
1881439016
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
JI IN KIM, D.D.S., PROFESSIONAL CORPORATION
Practice address
150 E Centennial Pkwy Ste 113
North Las Vegas, NV 89084-1338
Phone
(702) 642-1386
Fax
(702) 642-6321
NPI assigned
Jun 28, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ji In Kim, DDSNPI 1164677746
Title
Owner
Phone
(702) 642-1386

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X
Dental HygienistGroup: 193200000X MULTI-SPECIALTY GROUP 124Q00000X

Addresses

Primary practice location

150 E Centennial Pkwy Ste 113
North Las Vegas, NV 89084-1338

Mailing address

150 E Centennial Pkwy Ste 113
North Las Vegas, NV 89084-1338
Phone (702) 642-1386

Other names 1

  • Dynamic Dental Doing business as

National Provider Directory

National Provider Directory

Locations

150 E Centennial Pkwy
Ste 113
North Las Vegas, NV 89084
Phone (702) 642-1386

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1719532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1881439016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 E CENTENNIAL PKWY STE 113",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890841338",
            "telephone_number": "702-642-1386",
            "fax_number": "702-642-6321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 E CENTENNIAL PKWY STE 113",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890841338",
            "telephone_number": "702-642-1386",
            "fax_number": "702-642-6321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JI IN KIM, D.D.S., PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-28",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JI",
        "authorized_official_middle_name": "IN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-642-1386",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dynamic Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 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.

Verify at the official NPI Registry.