Moochan Kim, DDS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

13969 Issued in NC

Practice address

610 Dr Calvin Jones Hwy Ste 100
Wake Forest, NC 27587-3104

Phone

(919) 336-5230

NPI assigned

Jul 29, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• K. Kevin Neshat, DDS, MD, PA

  • Endodontics
  • Wake Forest, NC
  • NPI 1265117725
  NPD
• Geraldine Ross Bills DDS, P.a.

  • Dental Clinic/Center
  • Cary, NC
  • NPI 1619180759
  NPD (past)
• Dental Experts, LLC

  • General Practice Dentistry
  • Rockford, IL
  • NPI 1437320421
  NPD (past)
• Mary a. Nasso DDS & Eleanor J. Olsen DDS,PC

  • General Practice Dentistry
  • Staten Island, NY
  • NPI 1962444216
  NPD (past)

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

{
    "created_epoch": "1564358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725321600000",
    "number": "1992359954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4701 VIOLET FIELDS WAY UNIT 218",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276125660",
            "telephone_number": "917-421-0997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 DR CALVIN JONES HWY STE 100",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275873104",
            "telephone_number": "919-336-5230"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "875 Walnut St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Cary",
            "state": "NC",
            "postal_code": "275114215",
            "country_code": "US",
            "telephone_number": "919-467-8227",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "MOOCHAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-29",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02925300",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.032304",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "062241",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NC",
            "license": "13969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kidzcare Pediatrics, PC
• Casey Moore Kiefer, D.D.S.
• Abigail Rose Killinger
• Kim Holtmann Counseling PLLC
• Kim R. Melton, DDS, PHD, P.a.
• Myunghwan Kim
• Kimberly Scott, PLLC
• Chad Jerome Kimbrough, DDS
• Kindr Health Inc
• Mary Lee King, MSSA, LCSWA

• Endodontics in Wake Forest, NC
• Providers in Wake Forest, NC by specialty
• Endodontics in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2024; 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.