Kwang W Kim, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401412824 Issued in VA

Practice address

410 Mineral St
South Boston, VA 24592-3716

Phone

(434) 572-4928

Fax

(434) 572-4929

NPI assigned

Jun 14, 2010

Last updated

Feb 3, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 VA

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kwang W Kim, DDS, PLLC

  • General Practice Dentistry
  • South Boston, VA
  • NPI 1255061909
  NPD (past) Authorized official

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

{
    "created_epoch": "1276473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296691200000",
    "number": "1972824936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 MINERAL ST",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245923716",
            "telephone_number": "434-572-4928",
            "fax_number": "434-572-4929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 MINERAL ST",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245923716",
            "telephone_number": "434-572-4928",
            "fax_number": "434-572-4929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "KWANG",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-14",
        "last_updated": "2011-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401412824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suresh Gehan Jayatilaka, M.D.
• Warren Stephen Jones
• Christopher Charles Kemp, P.A.
• Marie Kathleen Ketchersid, MD
• Terry L Ketchersid
• Broderick Daryl King, MD
• Samantha Y King, MD
• Deborah Kipps-Vaughan, PSY. D.
• Senecca Elliott Kirkhart, CPNP
• Robert Joseph Krempl, DDS

• General Practice Dentistry in South Boston, VA
• Providers in South Boston, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2011; 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.