Active NPI
Jong Ryul Kim
- Endodontics
- Philadelphia, PA
National Provider Identifier
1982008959
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- DS041524
- Practice address
- 3223 N Broad St
Philadelphia, PA 19140-5007 - Phone
- (215) 707-2900
- NPI assigned
- Oct 20, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 0401414600 | VA | |
| Endodontics | 1223E0200X | DS041524 | PA | Primary |
Addresses
Primary practice location
3223 N Broad St
Philadelphia, PA 19140-5007
Mailing address
3223 N Broad St
Philadelphia, PA 19140-5007
Phone (215) 707-2900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- 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 |
|---|---|---|---|---|
| I20150617000315 | PA | Order and Referring Only - Oral Surgery | 2466763529 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401414600 | VA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1413763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671408000000",
"number": "1982008959",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3223 N BROAD ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191405007",
"telephone_number": "215-707-2900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3223 N BROAD ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191405007",
"telephone_number": "215-707-2900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JONG RYUL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-10-20",
"last_updated": "2022-12-19",
"certification_date": "2022-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "VA",
"license": "0401414600",
"primary": false
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "PA",
"license": "DS041524",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; 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.