DR. ELLY BUNSUN KIM (NPI# 1104174168) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104174168 |
| Entity Type | Individual |
| Full Name | DR. ELLY BUNSUN KIM |
| Credential | D.D.S. |
| Practice Address |
4201 Central Ave Nw Albuquerque NM 87105-1630 |
| Practice Telephone | 5058437172 |
| Enumeration Date | 2012-08-24 |
| Last Update Date | 2012-08-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
DD3755 | NM | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700232675 | Elly Jinok Kim | Nurse Practitioner | 260 East 188th Street, Bronx, NY 10458-3817 | 2016-05-10 |
| Street Address |
4201 CENTRAL AVE NW |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87105-1630 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508847567 | Frances Kathleen Lopez-bushnell | Nurse Practitioner | 4201 Central Ave Nw, Ste K3, Albuquerque, NM 87105-1630 | 2005-11-08 |
| 1306406772 | Juleini M Meneses | Dentist | 4201 Central Ave Nw, Albuquerque, NM 87105-1630 | 2019-06-18 |
| 1740635846 | Cade Clinical Consulting LLC | Nurse Practitioner | 4201 Central Ave Nw, Suite K-2, Albuquerque, NM 87105-1630 | 2016-04-27 |
| 1083000699 | Renal and Internal Medicine Consultant PC | Internal Medicine | 4201 Central Ave Nw, Suite K-2, Albuquerque, NM 87105-1630 | 2015-04-09 |
| 1699161216 | Turquoise Mesa LLC | Nurse Practitioner | 4201 Central Ave Nw, Suite K-2, Albuquerque, NM 87105-1630 | 2015-04-09 |
| 1124374004 | Julianne Austin | Family Medicine | 4201 Central Ave Nw, Suite K2, Albuquerque, NM 87105-1630 | 2012-07-30 |
| 1356633432 | Family Smiles, LLC | Dentist | 4201 Central Ave Nw, F-1, Albuquerque, NM 87105-1630 | 2011-05-09 |
| 1568768042 | Omni Medical Group LLC | Neuromusculoskeletal Medicine, Sports Medicine | 4201 Central Ave Nw, K3, Albuquerque, NM 87105-1630 | 2011-02-01 |
| 1427280767 | Milagro Physical Therapy, LLC | Physical Therapist | 4201 Central Ave Nw, Suite K-2, Albuquerque, NM 87105-1630 | 2009-08-20 |
| 1962567883 | Ramon Rosa Duarte | Internal Medicine | 4201 Central Ave Nw, Suite K-2, Albuquerque, NM 87105-1630 | 2006-12-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588278063 | Jacob Hill | Rehabilitation Practitioner | 2001-b El Centro Familiar Blvd Se, Albuqerque, NM 87105 | 2020-09-02 |
| 1083264824 | Kacie Rhodes | Technician | 515 Isleta Blvd Sw, Albuquerque, NM 87105 | 2019-09-13 |
| 1043870454 | Equal LLC | Assisted Living Facility | 207 Lagunitas Lane, Albuquerque, NM 87105 | 2019-06-18 |
| 1043792997 | Elizabeth Bennett | Counselor | 309 59th St Nw, Albuquerque, NM 87105 | 2018-09-06 |
| 1316439920 | Deann Nieto | Rehabilitation Practitioner | 2001b El Centro Familiar Blvd Sw, Albuquerque, NM 87105 | 2018-05-31 |
| 1487163457 | Karen Bejarano | Behavior Technician | 1847 Val Verde Rd Sw, Albuquerque, NM 87105 | 2017-09-21 |
| 1306360391 | Bendiciones Home Health Care | Home Health | 5500 Cleo Rd. Sw, Albuquerque, NM 87105 | 2017-08-01 |
| 1578927711 | Clarence Mills | Counselor | 1528 Five Points Rd Nw, Albuquerque, NM 87105 | 2016-04-13 |
| 1386024727 | Rachel Elaine Kadetz | Counselor | 1101 Lopez Rd. Sw, Albuquerque, NM 87105 | 2015-06-01 |
| 1598160772 | Sandra Jean Taylor | Lactation Consultant, Non-RN | 1305 Blake Rd Sw, Albuquerque, NM 87105 | 2014-10-30 |
| Find all providers in zip 87105 | ||||
| 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 |
|---|---|---|---|---|
| 1841803830 | Tri Dental, LLC | Dentist | 3715 Las Estancias Ct Sw Ste 101, Albuquerque, NM 87121-5506 | 2020-08-28 |
| 1609485077 | Joseph Potter | Dentist | 3510 Coors Blvd Sw, Albuquerque, NM 87121-5328 | 2020-07-30 |
| 1861024861 | Brian K Dennis Dds PC | Dentist | 8400 Osuna Rd Ne Ste 6a, Albuquerque, NM 87111-2073 | 2020-02-07 |
| 1134769235 | Abq Dentists PC | Dentist | 3900 Eubank Blvd Ne Ste 14, Albuquerque, NM 87111-3427 | 2020-01-07 |
| 1477197804 | Juan Tabo Dentistry LLC | Dentist | 1924 Juan Tabo Blvd Ne Ste C, Albuquerque, NM 87112-3358 | 2019-10-29 |
| 1013550094 | Bosque Smiles Dentistry, LLC | Dentist | 5600 Coors Blvd Nw Ste G4, Albuquerque, NM 87120-1877 | 2019-10-23 |
| 1134686298 | Brandon James Clayton | Dentist | 2003 Southern Blvd Se # 133-134, Albuquerque, NM 87124-3751 | 2019-02-25 |
| 1881158822 | Advantage Dental Care | Dentist | 9212 Montgomery Blvd Ne, Albuquerque, NM 87111-2408 | 2019-01-23 |
| 1124599253 | Kirtland Family Dentistry LLC | Dentist | 8521 Central Ave Ne Ste 101, Albuquerque, NM 87108-2501 | 2018-12-16 |
| 1962998443 | Salia Khayoumi | Dentist | 333 San Mateo Blvd Se, Albuquerque, NM 87108-2919 | 2018-07-08 |
| Find all providers in ALBUQUERQUE | ||||
| City | ALBUQUERQUE |
| Zip Code | 87105 |
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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.