Active NPI
Seo Young Kim
- Dentist
- Albuquerque, NM
National Provider Identifier
1962837617
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DD4649
- Practice address
- 5608 Zuni Rd SE
Albuquerque, NM 87108-2926 - Phone
- (505) 262-6547
- NPI assigned
- Sep 12, 2013
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DD4649 | NM | Primary |
Addresses
Primary practice location
5608 Zuni Rd SE
Albuquerque, NM 87108-2926
Mailing address
3728 11TH St NW
Apt a
Albuquerque, NM 87107
Phone (818) 333-6199
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170413001250 | NM | Order and Referring Only - Oral Surgery | 0143450452 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1378944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490745600000",
"number": "1962837617",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3728 11TH ST NW",
"address_2": "APT A",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "87107",
"telephone_number": "818-333-6199"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5608 ZUNI RD SE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871082926",
"telephone_number": "505-262-6547"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SEO YOUNG",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-09-12",
"last_updated": "2017-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NM",
"license": "DD4649",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2017; 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.