Sang Yoon Kim, DMD, MD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

0101251217 Issued in VA

Practice address

361 Maple Ave W
Suite 200
Vienna, VA 22180-4304

Phone

(703) 255-9400

Fax

(703) 255-4958

NPI assigned

Apr 3, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 1, 2014 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Christopher E. Bonacci DDS MD PC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Vienna, VA
  • NPI 1720006661
  NPD (past)

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371168000000",
    "number": "1992826333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "361 MAPLE AVE W",
            "address_2": "SUITE 200",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221804304",
            "telephone_number": "703-255-9400",
            "fax_number": "703-255-4958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "361 MAPLE AVE W",
            "address_2": "SUITE 200",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221804304",
            "telephone_number": "703-255-9400",
            "fax_number": "703-255-4958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SANG",
        "middle_name": "YOON",
        "name_prefix": "Dr.",
        "credential": "DMD, MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-03",
        "last_updated": "2013-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "VA",
            "license": "0101251217",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "VA",
            "license": "0401413454",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joon Kim
• Joongseo Kim, D.D.S.
• Ki S Kim, N.P.
• Mikyoung Kim, VA
• Renee S. Kim, L.AC
• Taeho Kim, MD
• Uriah Kim, PHARM.D.
• Janet Hutchison Kimberling, PH.D.
• Kinder Psychiatry PLLC
• Denys King, MS

• Oral & Maxillofacial Surgery (D.M.D.) in Vienna, VA
• Providers in Vienna, VA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2013; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.