Min C. Kim, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

051705 Issued in NY

Practice address

3145 Garden Ave Ste 1278
Fort Sam Houston, TX 78234-7719

Phone

(210) 808-3735

NPI assigned

Jul 25, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1185321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1912107194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4270 GORGAS CIRCLE",
            "address_2": "ATTN: ROBERTA DRISKILL",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782342639",
            "telephone_number": "210-221-6326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3145 GARDEN AVE STE 1278",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782347719",
            "telephone_number": "210-808-3735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MIN",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-25",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "051705",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "051705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer M Kiley, RDH
• Phyliss Kilpatrick, LMSW-IPR, LCDC
• Bohan Daniel Kim, MD
• David Kim
• Heesung Steve Kim, DDS
• Rosalynn Kyung-Mi Kim, DO
• Megan C King
• Lila Lee Kinser, R.N.
• Jessica Marie Kirk, DO
• William Kirk, RN

• Pediatric Dentistry in Fort Sam Houston, TX
• Providers in Fort Sam Houston, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.