Jeffrey Mark Kim, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DN13917 Issued in FL

Practice address

4570 S Clyde Morris Blvd
Suite 1
Port Orange, FL 32129-5401

Phone

(386) 322-4867

Fax

(386) 322-3899

NPI assigned

Jan 5, 2012

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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 and National Provider Directory roles.

• J. Kim Periodontics, LLC

  • Periodontics
  • Port Orange, FL
  • NPI 1629198551
  NPD (past) Authorized official

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

{
    "created_epoch": "1325721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325721600000",
    "number": "1982974135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4570 S CLYDE MORRIS BLVD",
            "address_2": "SUITE 1",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321295401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4570 S CLYDE MORRIS BLVD",
            "address_2": "SUITE 1",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321295401",
            "telephone_number": "386-322-4867",
            "fax_number": "386-322-3899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JEFFREY",
        "middle_name": "MARK",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-01-05",
        "last_updated": "2012-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "DN13917",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "DN13917",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amer Khatib, MD
• Kareena Khemlani
• Kelly S Kiah, D.N.P.
• Lauren Kienzl
• Amy Jung in Kim, MD
• Kirsten S. Kim, M.D.
• Leonard Kim
• Amanda Kimbler
• Carson King, PT, DPT
• Edward Cecil King, LCSW

• Periodontics in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Periodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2012; 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.