Su Jung Kim

Primary specialty

DentistTaxonomy code 122300000X

License

12936 Issued in CT

Practice address

3 Research Dr
Woodbridge, CT 06525-2348

Phone

(203) 409-2535

NPI assigned

Jun 24, 2019

Sex

Female

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

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1561334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656720000000",
    "number": "1952962649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 PARK ST APT 12T",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065115421",
            "telephone_number": "929-400-2023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 RESEARCH DR",
            "city": "WOODBRIDGE",
            "state": "CT",
            "postal_code": "065252348",
            "telephone_number": "203-409-2535"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4500 Parsons Blvd",
            "address_purpose": "LOCATION",
            "city": "Flushing",
            "state": "NY",
            "postal_code": "113552205",
            "country_code": "US",
            "telephone_number": "929-400-2023",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "111 Park St Apt 12T",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "065115421",
            "country_code": "US",
            "telephone_number": "929-400-2023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "SU JUNG",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-24",
        "last_updated": "2022-07-02",
        "certification_date": "2022-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "12936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Katz, MD
• Kaydian Harrison LCSW LLC
• Arlene Kaye, BCBA
• James A Killian, LPC
• Mijung Kim, APRN
• Charles F. Kirby III, LMSW-CC
• Hedy Kober, PHD
• Shamlee A Kulkarni, RD
• Lacc LLC
• Bianca Lastra

• Dentist in Woodbridge, CT
• Providers in Woodbridge, CT by specialty
• Dentist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2022; 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.

Verify at the official NPI Registry.