RODERICK YOUNGDO KIM (NPI# 1689954562) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689954562 |
| Entity Type | Individual |
| Full Name | RODERICK YOUNGDO KIM |
| Credential | DDS, MD |
| Practice Address |
1500 S Main St Dept Of Fort Worth TX 76104-4917 |
| Mailing Address |
1500 South Main Department of Omfs Fort Worth TX 76104 |
| Practice Telephone | 8177026936 |
| Enumeration Date | 2011-08-23 |
| Last Update Date | 2017-07-06 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 204E00000X | Oral & Maxillofacial Surgery | 32838 | TX | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | R2899 | TX | Student, Health Care |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | 4301108492 | MI | Student, Health Care |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | 2901020498 | MI | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922066984 | Roderick Kim | Internal Medicine | 1000 E Paris Ave Se, Suite 260, Grand Rapids, MI 49546-3680 | 2006-05-01 |
| Street Address |
1500 S MAIN ST DEPT OF |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76104-4917 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669082186 | Cvs Pharmacy, Inc. | Durable Medical Equipment & Medical Supplies | 1115 8th St, Fort Worth, TX 76104 | 2020-08-10 |
| 1992343693 | Iris Giove | Psychologist | John Peter Smith Hospital, 1500 S. Main St., Fort Worth, TX 76104 | 2019-12-13 |
| 1104480656 | Swarnalaxmi Umapathy | Student in an Organized Health Care Education/Training Program | 900 8th Avenue, Fort Worth, TX 76104 | 2019-04-30 |
| 1881189132 | Mega Surgical Assistants LLC | Specialist/Technologist, Other | 1301pennsylvania, Fort Worth, TX 76104 | 2018-06-28 |
| 1356848899 | Tricia Kelly | Nurse Practitioner | 1325 Pennsylvania Avenue Suite 560, Fort Worth, TX 76104 | 2018-04-11 |
| 1952820979 | Modern Vein Clinic | Internal Medicine | 757 8th Avenue, Suite A, Forth Worth, TX 76104 | 2017-09-11 |
| 1790207165 | Vanessa Abbood | Dietitian, Registered | 900 Eighth Ave, Fns Department, Fort Worth, TX 76104 | 2017-07-07 |
| 1922537562 | Nicole Marie Tod | Student in an Organized Health Care Education/Training Program | 1500 S Main Street, Fort Worth, TX 76104 | 2017-06-07 |
| 1770025934 | Micah Bonola | Chiropractor | 1300 W. Rosedale St, Ste. A, Fort Worth, TX 76104 | 2016-11-04 |
| 1518315894 | United Bioscience, LLC. | Clinical Medical Laboratory | 901 W. Leuda St., B, Fort Worth, TX 76104 | 2016-05-27 |
| Find all providers in zip 76104 | ||||
| Taxonomy Code | 204E00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Oral & Maxillofacial Surgery |
| Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. |
| Notes: Source: American College of Surgeons, 2013. www.facs.org [7/1/2013: definition added, source added, additional resources added] Additional Resources: American Board of Oral and Maxillofacial Surgery and American Association of Oral and Maxillofacial Surgeons While this is generally considered a specialty of dentistry, physicians can also be board certified as oral and maxillofacial surgeons through the American Board of Oral and Maxillofacial Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508375965 | Dioms, Pllc | Oral & Maxillofacial Surgery | 9676 Bartlett Cir Ste 950, Fort Worth, TX 76108-4469 | 2017-09-28 |
| 1316180821 | Siavash Eftekhari | Oral & Maxillofacial Surgery | 1625 Saint Louis Ave, Fort Worth, TX 76104-7635 | 2009-04-14 |
| 1790758563 | Jefferson Roy Lowry | Oral & Maxillofacial Surgery | 1250 8th Ave, Suite 135, Fort Worth, TX 76104 | 2006-02-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477101053 | College Station Oral Surgery, Pllc | Oral & Maxillofacial Surgery | 1645 Greens Prairie Rd W Ste 202, College Station, TX 77845-8414 | 2019-08-28 |
| 1922579473 | Christopher M. King, Dds, Md, Pllc | Oral & Maxillofacial Surgery | 5209 Heritage Ave Ste 220, Colleyville, TX 76034-5997 | 2018-12-10 |
| 1063908671 | Steven C. Albright Dds, Pa | Oral & Maxillofacial Surgery | 15600 San Pedro Ave Ste 107, San Antonio, TX 78232 | 2018-07-06 |
| 1730625740 | Facial Head & Neck Surgery Pllc | Oral & Maxillofacial Surgery | 2317 Coit Rd Ste A, Plano, TX 75075-3774 | 2017-01-13 |
| 1821405416 | Caprock Oral Surgery, Pllc | Oral & Maxillofacial Surgery | 5730 66th St., Lubbock, TX 79424-1224 | 2014-07-16 |
| 1487997813 | Amir All-atabakhsh | Oral & Maxillofacial Surgery | 2402 Rice Blvd Ste C, Houston, TX 77005-3203 | 2013-04-04 |
| 1225398456 | Associates In Oral & Implant Surgery | Oral & Maxillofacial Surgery | 7211 North Mesa Suite 1 South, El Paso, TX 79912 | 2012-05-22 |
| 1437419652 | Associates In Oral & Implant Surgery | Oral & Maxillofacial Surgery | 7211 North Mesa Suite 1-south, El Paso, TX 79912 | 2012-05-22 |
| 1891923843 | Blake Dyson Maida | Oral & Maxillofacial Surgery | 7500 San Felipe St Ste 300, Houston, TX 77063-1716 | 2009-06-29 |
| 1669609285 | Jia-woei Wang | Oral & Maxillofacial Surgery | 5525 S. Staples, A-4, Corpus Christi, TX 78411 | 2009-06-22 |
| Find all providers with the same taxonomy | ||||
| City | FORT WORTH |
| Zip Code | 76104 |
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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.