JAE SEON KIM (NPI# 1053672022) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053672022 |
| Entity Type | Individual |
| Full Name | JAE SEON KIM |
| Credential | DDS |
| Practice Address |
1430 John Wesley Gilbert Drive Gc-1024 Augusta GA 30912-1001 |
| Practice Telephone | 7067219633 |
| Practice Fax Number | 7067230266 |
| Mailing Telephone | 7067219633 |
| Mailing Fax Number | 7067230266 |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2012-06-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0700X |
Dentist Specialization: Prosthodontics |
DNF000366 | GA | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558778100 | Jae Kim | Pharmacist | 14474 37th Ave, 1st Floor, Flushing, NY 11354-5934 | 2014-07-15 |
| 1215274865 | Jae S. Kim | Dentist | 1025 N Fillmore St, A, Arlington, VA 22201-6701 | 2013-01-15 |
| 1306112875 | Jae Hee Kim | Pharmacist | 1202 N 10th Pl Apt 1214, Renton, WA 98057-5635 | 2012-03-28 |
| 1548531536 | Jae Chil Kim | Physical Medicine & Rehabilitation | 107 Redcliff Dr, Jefferson Hills, PA 15025-3139 | 2012-01-23 |
| 1407143191 | Jae Man Kim | Acupuncturist | 3409 W Burbank Blvd, Burbank, CA 91505-2233 | 2011-07-01 |
| 1609168327 | Jae Y Kim | Otolaryngology | 2200 Wilson Blvd Ste 102-219, Arlington, VA 22201-3397 | 2011-05-12 |
| 1689849176 | Jae Hyun Kim | Prosthetist | 1918 Coliseum Blvd, Greensboro, NC 27403-3211 | 2008-04-25 |
| 1477745388 | Jae Woo Kim | Dentist | 403 N Five Points Rd, West Chester, PA 19380-4632 | 2007-08-14 |
| 1083832273 | Jae Gwon Kim | Dentist | 777 N. Rainbow Blvd., Ste. 395, Las Vegas, NV 89107 | 2007-04-23 |
| 1043359482 | Jae Seung Kim | Acupuncturist | 3400 W Olympic Bl, Ste207, Los Angeles, CA 90019-2122 | 2007-02-05 |
| Street Address |
1430 JOHN WESLEY GILBERT DRIVE GC-1024 |
| City | AUGUSTA |
| State | GA |
| Zip Code | 30912-1001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811978927 | Andrew Robert Kious | Dentist | 1430 John Wesley Gilbert Drive, Ghsu College of Dental Medicine, Augusta, GA 30912 | 2005-11-07 |
| 1801421268 | Cassandra Nicole Liston | Student in an Organized Health Care Education/Training Program | 1430 John Wesley Gilbert Drive, Augusta, GA 30912-0001 | 2020-03-05 |
| 1710511738 | Amara Altman | Student in an Organized Health Care Education/Training Program | 1430 John Wesley Gilbert Drive, Dental College of Georgia, Augusta, GA 30909 | 2020-02-28 |
| 1316571318 | Macy Malcom Copelan | Student in an Organized Health Care Education/Training Program | 1430 John Wesley Gilbert Drive, Augusta, GA 30912-0001 | 2020-02-27 |
| 1447884770 | Shane Mitchell Turgeon | Student in an Organized Health Care Education/Training Program | 1430 John Wesley Gilbert Drive, Augusta, GA 30912-0001 | 2020-02-25 |
| 1295368918 | Jackie Janzen | Dentist | 1430 John Wesley Gilbert Drive, Augusta, GA 30912-0001 | 2020-02-20 |
| 1275195984 | Anh Nguyen | Dentist | 1430 John Wesley Gilbert Drive, Augusta, GA 30912-5042 | 2019-07-02 |
| 1508328824 | Skylar Yearous | Student in an Organized Health Care Education/Training Program | 1430 John Wesley Gilbert Drive, College of Dental Medicine Pedodontics - Gc 2116, Augusta, GA 30901 | 2019-04-04 |
| 1659832657 | Mahmoud Elashiry | Student in an Organized Health Care Education/Training Program | 1430 John Wesley Gilbert Drive, Augusta, GA 30912-0001 | 2019-03-31 |
| 1942761267 | Eric Hatten | Student in an Organized Health Care Education/Training Program | 1430 John Wesley Gilbert Drive, Augusta, GA 30912-0001 | 2019-03-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548885940 | Hannah Gullickson Folsom | Family Medicine | 1459 Laney Walker Blvd Ae 3042, Augusta, GA 30912 | 2020-06-11 |
| 1487278909 | Robert Kennedy | Internal Medicine | Augusta University Internal Medicine Residency Program, 1120 15th Street, Bi 5070, Augusta, GA 30912 | 2020-06-01 |
| 1952968737 | Kayla M. Lasota | Pediatrics | 11230 115th St Ae3042, Augusta, GA 30912 | 2019-05-28 |
| 1003379280 | Kayla Cox | Internal Medicine | 1120 15th St Bi5070, Augusta, GA 30912 | 2019-04-13 |
| 1619435740 | Justin Ray Mackert | Student in an Organized Health Care Education/Training Program | Augusta University, 1120 15th Street, Gc 5110, Augusta, GA 30912 | 2019-03-07 |
| 1417444167 | Victor Celis | Dentist | John Wesley Gilbert Dr, Augusta, GA 30912 | 2018-04-18 |
| 1487157921 | Julie Ann Matsen | Student in an Organized Health Care Education/Training Program | 997 St. Sebastian Way, Eg-2021-10, Augusta Univ., Dept. of Psychiatry & Health Behavior, Augusta, GA 30912 | 2018-03-12 |
| 1497287031 | Luke Yuung-jier Chang | Ophthalmology | 1120 15th St # Ba2720, Augusta, GA 30912 | 2017-04-02 |
| 1821537622 | Lashawn Kay Boone | Nurse Practitioner | 1445 Harper St, Augusta, GA 30912 | 2017-02-14 |
| 1134675564 | Arnab Saha | Internal Medicine | 1120 15 Th St., Augusta, GA 30912 | 2016-08-26 |
| Find all providers in zip 30912 | ||||
| Taxonomy Code | 1223P0700X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Prosthodontics |
| That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265815997 | Fadi Al Farawati | Dentist | Au Dental Associates 1430 John Wesley Gilbert Drive, Augusta, GA 30912-0415 | 2015-06-30 |
| 1467693952 | Cathy J Smith | Dentist | 4469 Columbia Rd Ste E, Augusta, GA 30907-4572 | 2009-03-13 |
| 1306068192 | Kent Knoernschild | Dentist | 1120 15th Street, Gc-4200, Augusta, GA 30912 | 2007-05-03 |
| 1801226931 | Ahmed Morsy Elsayed Zaher | Dentist | 1430 John Wesley Gilbert Drive, Faculty Practice (gru School of Dentistry), Augusta, GA 30912 | 2013-11-27 |
| 1215232103 | Abdulmohsin H Alhashim | Dentist | 1430 John Wesley Gilbert Drive, Gc-1024, Augusta, GA 30912-1001 | 2011-01-24 |
| 1326352162 | Darshanjit Singh Pannu | Dentist | 1459 Laney Walker Blvd, Ad-1119, Augusta, GA 30912-0002 | 2010-08-04 |
| 1104054816 | Andreina Josefina Sananez | Dentist | 1120 15th St, Oral Rehabilitation Dept. Gc-4222, Augusta, GA 30912-0004 | 2009-07-01 |
| 1982859203 | Eduardo E Britton | Dentist | 1430 John Wesley Gilbert Drive, Augusta, GA 30912-0004 | 2008-12-01 |
| 1225294408 | Jimmy Londono | Dentist | 1459 Laney Walker Blvd, Ad-1500, Augusta, GA 30912-0002 | 2008-08-06 |
| 1194944645 | Gerard Jules Chiche | Dentist | 1430 John Wesley Gilbert Drive, Gc-1024, Augusta, GA 30912-1001 | 2007-04-24 |
| Find all providers in AUGUSTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.