Sung Soo Kim, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401413002 Issued in VA

Practice address

4TH and Inner Loop Road
BLDG 171
Fort Irwin, CA 92310

Phone

(719) 526-5537

NPI assigned

Jul 18, 2011

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

Other identifiers 1

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": "1310947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680048000000",
    "number": "1932497500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1667 COCHRANE CIR BLDG 7495",
            "city": "FORT CARSON",
            "state": "CO",
            "postal_code": "809134603",
            "telephone_number": "719-526-5537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4TH AND INNER LOOP ROAD",
            "address_2": "BLDG 171",
            "city": "FORT IRWIN",
            "state": "CA",
            "postal_code": "92310",
            "telephone_number": "719-526-5537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SUNG",
        "middle_name": "SOO",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-18",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401413002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTIST LICENSE",
            "identifier": "0401413002",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Edwin Kelley, PH.D.
• Paul Henry Lardizabal Kiley, R.N.
• Hye H Kim, DDS
• Ji Kim
• Kihyun Kim, D.O.
• Yong Soo Kim, DDS
• Todd Shuji Kimura, DDS
• Barbara Jeannette King, RN
• Brittany M Kirch, DO
• Kathyrn Elisabeth Klawitter, R.N.

• General Practice Dentistry in Fort Irwin, CA
• Providers in Fort Irwin, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; 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.