Individual provider Active NPI

Grace E. Kim, DMD

  • Dentist
  • Okatie, SC
National Provider Identifier
1972961696
Registry record updated Aug 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
9463 Issued in SC
Practice address
719 Okatie Hwy
Okatie, SC 29909-3963
Phone
(843) 298-2551
NPI assigned
Feb 9, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 9463 SC Primary

Addresses

Primary practice location

719 Okatie Hwy
Okatie, SC 29909-3963

Mailing address

721 Okatie Hwy # 170
Okatie, SC 29909-3963
Phone (843) 987-7400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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

Enrollment IDStateProvider typePAC IDDetails
I20200828000359 SC Practitioner - Dentist 3375818362 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Beaufort Jasper Hampton Comprehensive Health Services, Inc. CurrentSince Aug 21, 2020 Accepting new patients
Beaufort Jasper Hampton Comprehensive Health Services, Inc CurrentSince Aug 21, 2020 Accepting new patients

Locations

721 Okatie Hwy
Okatie, SC 29909

719 Okatie Hwy
Okatie, SC 29909
Phone (843) 987-7408

721 N Okatie Hwy
Ridgeland, SC 29936
Phone (843) 987-7492

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EICIBD

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1454976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598313600000",
    "number": "1972961696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 OKATIE HWY # 170",
            "city": "OKATIE",
            "state": "SC",
            "postal_code": "299093963",
            "telephone_number": "843-987-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 OKATIE HWY",
            "city": "OKATIE",
            "state": "SC",
            "postal_code": "299093963",
            "telephone_number": "843-298-2551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "GRACE",
        "middle_name": "E.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-09",
        "last_updated": "2020-08-25",
        "certification_date": "2020-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "9463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Okatie, SC

Sources for this page

Verify at the official NPI Registry.