DR. JAE KIM (NPI# 1548632607) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1548632607 |
Entity Type | Individual |
Full Name | DR. JAE KIM |
Credential | D.D.S |
Practice Address |
144 Boston Ave Bridgeport CT 06610-1604 |
Mailing Address |
1955 Lake Ave Altadena CA 91001-3037 |
Practice Telephone | 2034377561 |
Enumeration Date | 2015-10-28 |
Last Update Date | 2018-03-17 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 1223G0001X |
Dentist Specialization: General Practice |
65151 | CA | Dental Providers |
Y | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
12130 | CT | Dental Providers |
N | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
65151 | CA | Dental Providers |
Address | Telephone Number | Fax Number |
---|---|---|
531 Elm St, New Haven, CT 065114549 | 2039011323 |
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 |
144 BOSTON AVE |
City | BRIDGEPORT |
State | CT |
Zip Code | 06610-1604 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1538392170 | Wolcott Street Dental-2, PC | Dentist | 144 Boston Ave, Bridgeport, CT 06610-1604 | 2009-08-31 |
1629487293 | Manmeet Kaur Arora | Dentist | 144 Boston Ave, Bridgeport, CT 06610-1604 | 2014-08-08 |
1730598285 | Nirali Merchant | Dentist | 144 Boston Ave, Bridgeport, CT 06610-1604 | 2014-08-08 |
1386955193 | Lalit Kapoor | Dentist | 144 Boston Ave, Bridgeport, CT 06610-1604 | 2010-06-25 |
1730316597 | Saima A Khan | Dentist | 144 Boston Ave, Bridgeport, CT 06610-1604 | 2009-06-18 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1215553698 | Juan G Farfan | Nurse Anesthetist, Certified Registered | 267 Grant Sreet, Bridgeport, CT 06610 | 2020-06-22 |
1104446145 | Deepak Rajkumar Vangipuram | Student in an Organized Health Care Education/Training Program | Department of Medicine, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610 | 2020-04-20 |
1275152886 | Soniya Abraham | Student in an Organized Health Care Education/Training Program | Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610 | 2020-04-14 |
1538621834 | Yu Mi Kang | Student in an Organized Health Care Education/Training Program | 267 Grant Street, Yale New Haven Health/bridgeport Hosp, Bridgeport, CT 06610 | 2019-04-04 |
1073075024 | Ashwin Pramod Deshmukh | Student in an Organized Health Care Education/Training Program | Yale New Haven Health / Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610 | 2019-04-01 |
1790246866 | Prachi Mangesh Pednekar | Student in an Organized Health Care Education/Training Program | Yale New Haven Health/bridgeport Hospital, 261 Grant Street Department of Internal Medicine, Bridgeport, CT 06610 | 2019-03-29 |
1194247916 | Jessica M. Maddern | Social Worker | 1558 Barnum Avenue, Building C, Bridgeport, CT 06610 | 2017-07-13 |
1922532746 | Megha Kureti | Student in an Organized Health Care Education/Training Program | 267 Grant St Fl 3, Bridgeport, CT 06610 | 2017-04-18 |
1831623099 | Cynthia Joseph Walters | Nurse Anesthetist, Certified Registered | Bridgeport Hospital-anesthesia Department, 267 Grant Street, Bridgeport, CT 06610 | 2017-04-14 |
1285186148 | Helen Leahy | Nurse Practitioner | 439 Mill Hill Ave., Bridgeport, CT 06610 | 2016-10-26 |
Find all providers in zip 06610 |
Taxonomy Code | 1223X0400X |
Grouping | Dental Providers |
Classification | Dentist |
Specialization | Orthodontics and Dentofacial Orthopedics |
That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1750696399 | Connecticut Family Dental, Inc | Dentist | 3885 Main St, Suite 101, Bridgeport, CT 06606-2814 | 2010-08-06 |
1922271550 | Shyam Desai | Dentist | 3741 Main St, Bridgeport, CT 06606-3609 | 2008-04-03 |
1356560346 | Drs. Lacy & Weidman, Pllc | Dentist | 112 Hill St, Bridgeport, WV 26330-1756 | 2007-04-25 |
1184605974 | Michael B Montanaro | Dentist | 5294 Park Ave, Bridgeport, CT 06604-1018 | 2005-11-08 |
1316571425 | Myorthos Connecticut Orthodontics PC | Dentist | 3909 Main St, Bridgeport, CT 06606-2872 | 2020-02-27 |
1184258386 | Myorthos Holdings, LLC | Dentist | 3909 Main St, Bridgeport, CT 06606-2872 | 2020-02-26 |
1700378916 | Arthur Kim | Dentist | 2690 E Main St, Bridgeport, CT 06610-1422 | 2018-06-04 |
1881048080 | Bridgeport Braces, LLC | Dentist | 3715 Main St, Suite 100, Bridgeport, CT 06606-3618 | 2016-04-14 |
1588048748 | Ct Braces Bridgeport Orthodontics PC | Dentist | 3909 Main St, Suite A, Bridgeport, CT 06606-2872 | 2015-07-16 |
1467886614 | Ismile Orthodonticsof LLC | Dentist | 2417 E Main St, Bridgeport, CT 06610-1802 | 2013-08-23 |
Find all providers in BRIDGEPORT |
City | BRIDGEPORT |
Zip Code | 06610 |
Please comment or provide details below to improve the information on DR. JAE KIM.
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.