Active NPI
Myoung-Wook Kim, DDS
- General Practice Dentistry
- Fredericksburg, VA
National Provider Identifier
1962711374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 14352
- Practice address
- 5630 Plank Rd
Fredericksburg, VA 22407-6641 - Phone
- (540) 548-4025
- Fax
- (888) 711-1858
- NPI assigned
- Oct 3, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 14352 | MD | Primary |
Addresses
Primary practice location
5630 Plank Rd
Fredericksburg, VA 22407-6641
Mailing address
4670 Prestancia PL
#304
Waldorf, MD 20602-4123
Phone (917) 929-4475
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14352 | MD | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1286064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1286064000000",
"number": "1962711374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4670 PRESTANCIA PL",
"address_2": "#304",
"city": "WALDORF",
"state": "MD",
"postal_code": "206024123",
"telephone_number": "917-929-4475"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5630 PLANK RD",
"city": "FREDERICKSBURG",
"state": "VA",
"postal_code": "224076641",
"telephone_number": "540-548-4025",
"fax_number": "888-711-1858"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MYOUNG-WOOK",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-10-03",
"last_updated": "2010-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MD",
"license": "14352",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fredericksburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.