Jae DO Kim, D.D.S.

General Practice Dentistry · Fort Bragg, CA

Individual Active NPI

NPI number 1437501566

Practice location

205 South St
Fort Bragg, CA 95437-5540
Phone
(707) 961-4088

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NPI record

NPI
1437501566
Entity type
Individual (Type 1)
Enumeration date
July 13, 2016
Last updated
March 7, 2023
Sole proprietor
Yes

Specialties & taxonomy codes

TaxonomyCodeLicenseState
General Practice Dentistry Primary 1223G0001X 102969 CA
Student in an Organized Health Care Education/Training Program 390200000X — NY

Mailing address

5120 NW 17TH St
Oklahoma City, OK 73127-2858
Phone
(678) 717-9568

Other practice locations (1)

  • 1 Brookdale Plz, Brooklyn, NY 11212-3139 · (718) 240-6552

About Dr. Kim

Jae DO Kim, D.D.S. is a healthcare provider registered in the NPI registry with the primary taxonomy General Practice Dentistry (code 1223G0001X). The practice location is 205 South St, Fort Bragg, CA 95437-5540. The NPI number 1437501566 was assigned on July 13, 2016 and the record was last updated on March 7, 2023.

Dr. Kim lists a license in the registry: #102969 (CA) for General Practice Dentistry. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Jae DO Kim, D.D.S.?

The NPI number is 1437501566.

What is the phone number of Dr. Kim?

The phone number listed for the practice location is (707) 961-4088.

Where is Dr. Kim located?

205 South St, Fort Bragg, CA 95437-5540.

What is the taxonomy code for Dr. Kim?

The primary taxonomy code is 1223G0001X – General Practice Dentistry; 1 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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