John Norman Kimmich, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

013590 Issued in MO

Practice address

195 S Main St
Dupo, IL 62239-1347

Phone

(618) 286-4400

Fax

(618) 286-4407

NPI assigned

Mar 4, 2008

Last updated

Oct 30, 2012By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1204588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351555200000",
    "number": "1972773281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 S MAIN ST",
            "city": "DUPO",
            "state": "IL",
            "postal_code": "622391347",
            "telephone_number": "618-286-4400",
            "fax_number": "618-286-4407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 S MAIN ST",
            "city": "DUPO",
            "state": "IL",
            "postal_code": "622391347",
            "telephone_number": "618-286-4400",
            "fax_number": "618-286-4407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMMICH",
        "first_name": "JOHN",
        "middle_name": "NORMAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-04",
        "last_updated": "2012-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "013590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Dupo, IL
• Providers in Dupo, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2012; 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.