JAE DO KIM (NPI# 1437501566) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1437501566 |
Entity Type | Individual |
Full Name | JAE DO KIM |
Credential | D.D.S. |
Practice Address |
205 South St Fort Bragg CA 95437-5540 |
Mailing Address |
5120 Nw 17th St Oklahoma City OK 73127-2858 |
Practice Telephone | 7079614088 |
Mailing Telephone | 6787179568 |
Enumeration Date | 2016-07-13 |
Last Update Date | 2018-09-13 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 1223G0001X |
Dentist Specialization: General Practice |
102969 | CA | Dental Providers |
N | 390200000X | Student in an Organized Health Care Education/Training Program | NY | Student, Health Care |
State | Issuer | Identifier | Type Code |
---|---|---|---|
IA | DEA | FK7241918 | 01 |
Address | Telephone Number | Fax Number |
---|---|---|
1 Brookdale Plz, Brooklyn, NY 112123139 | 7182406552 | 7182406682 |
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 |
205 SOUTH ST |
City | FORT BRAGG |
State | CA |
Zip Code | 95437-5540 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1508861782 | Wade Joseph Gray | Family Medicine | 205 South St, Fort Bragg, CA 95437-5540 | 2005-06-15 |
1477046027 | Roy Campbell | Dental Hygienist | 205 South St, Fort Bragg, CA 95437-5540 | 2018-06-08 |
1457861783 | Andrea Masters | Nurse Practitioner | 205 South St, Fort Bragg, CA 95437-5540 | 2017-09-29 |
1558790774 | Nadege Nerette | Physician Assistant | 205 South St, Fort Bragg, CA 95437-5540 | 2013-11-07 |
1932532272 | Svetlana Romanovna Mulcahy | Nurse Practitioner | 205 South St, Fort Bragg, CA 95437-5540 | 2013-08-09 |
1013257831 | Kimberly Jill Celeri | Dental Hygienist | 205 South St, Fort Bragg, CA 95437-5540 | 2013-02-15 |
1821340480 | Genevieve Marilyn Gonzalez | Counselor | 205 South St, Fort Bragg, CA 95437 | 2012-10-08 |
1447500988 | Ted Michael Aames | Counselor | 205 South St, Fort Bragg, CA 95437-5540 | 2012-09-12 |
1740587229 | Wendy J Carvajal | Dentist | 205 South St, Fort Bragg, CA 95437-5540 | 2011-02-18 |
1073841540 | Lynne Barbara Bornheim | Social Worker | 205 South St, Fort Bragg, CA 95437 | 2009-11-21 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1902357437 | Mendocino Coast Hospitality Center | Community/Behavioral Health | 137 E. Oak Street, Fort Bragg, CA 95437 | 2016-10-19 |
1144604570 | Erin Paul | Community Health Worker | 474 South Franklin Street, Fort Bragg, CA 95437 | 2015-07-15 |
1508125790 | Joel Macgregor Green | Marriage & Family Therapist | 331- G Redwood Ave., Fort Bragg, CA 95437 | 2012-05-09 |
1013244102 | Jenna Glasscock | Counselor | 331 E Redwood Ave, Ste E, Fort Bragg, CA 95437 | 2009-11-10 |
1770819641 | Patrick Lenaghan | Emergency Medicine | 707 River Dr, Fort Bragg, CA 95437 | 2009-10-27 |
1043455827 | M. Lee Baker | Dentist | 890 River Dr, Fort Bragg, CA 95437 | 2008-12-09 |
1528250495 | Christine Anne Samas | Social Worker | 656a Harrison St., Fort Bragg, CA 95437 | 2007-08-15 |
1083822811 | Katharine L. White | Marriage & Family Therapist | 137 E Oak Street, Fort Bragg, CA 95437 | 2007-05-17 |
1053525873 | Marty Christine Johnson | Marriage & Family Therapist | 331 E. Redwood Ave, Fort Bragg, CA 95437 | 2007-05-10 |
1528114741 | Kate Teresa Donohue | Psychologist | 19201 Noyo Acres Dr, Fort Bragg, CA 95437 | 2007-01-29 |
Find all providers in zip 95437 |
Taxonomy Code | 1223G0001X |
Grouping | Dental Providers |
Classification | Dentist |
Specialization | General Practice |
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
Notes: Source: Academy of General Dentistry |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1750997110 | William James Graham Iv | Dentist | Bldg B-6837 Normandy Dr, Fort Bragg, NC 28310-0001 | 2020-09-21 |
1679194906 | Jeff Bertheola | Dentist | 825 Sequoia Cir, Fort Bragg, CA 95437-5422 | 2020-04-27 |
1114572229 | Amanda C Blankenship | Dentist | Smoke Bomb Hill Dental Clinic 3817 Gruber Rd, Fort Bragg, NC 28310-0001 | 2019-08-06 |
1831754795 | Ryan David Smith | Dentist | Bldg 4681 Logistics Ave, Fort Bragg, NC 28310-0001 | 2019-05-07 |
1588159263 | Jenniffer Rendon-velasquez | Dentist | 3817 Gruber Rd, Fort Bragg, NC 28310-8925 | 2018-06-26 |
1912423377 | Lejla Streets | Dentist | 2827 Reilly Rd, Fort Bragg, NC 28310-0001 | 2017-08-17 |
1033635420 | Andrew Seun | Dentist | Bldg 6837 Normandy Drive, Fort Bragg, NC 28310-0001 | 2017-08-17 |
1184144479 | Thomas William Hanna IIi | Dentist | Bldg C-6238 Ardennes St., Fort Bragg, NC 28307 | 2017-06-27 |
1598134769 | Sidney Choi | Dentist | 499 E Chestnut St, Fort Bragg, CA 95437-4913 | 2015-09-17 |
1083048706 | Gamal Ahmad Baker | Dentist | Logisitcs Ave Bldg M-4861, Us Army Dental Activity, Fort Bragg, NC 28310-7302 | 2013-08-29 |
Find all providers in FORT BRAGG |
City | FORT BRAGG |
Zip Code | 95437 |
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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.