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Active NPI 1437501566 Individual Practitioner Male Practitioner

Dr. Jae Do Kim , DDS

Dentist - General Practice • Fort Bragg, CA

Professional Overview & Biography Verified Profile Summary

Dr. Jae Kim, DDS is a registered healthcare professional specializing in Dentist - General Practice in Fort Bragg, CA. Practice services are available at 205 SOUTH ST under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

205 South St

Fort Bragg, CA 954375540

Telephone 7079614088

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Fort Bragg, CA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 21.7 Yrs
Regional Practice Density
6 Specialists

Practicing in Fort Bragg, CA (18734 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License CA 102969

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.

Student in an Organized Health Care Education/Training Program

NUCC Taxonomy Code: 390200000X

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Secondary Practice Locations

1 Brookdale Plz

Brooklyn, NY 112123139

Phone: 7182406552

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

5 Associated Practitioners
Lynne Bornheim , LCSW

Social Worker - Clinical

NPI 1073841540

Licensed Clinical Social Worker

David Stein , ASW

Social Worker - Clinical

NPI 1104999606

Associate Social Worker

NPI 1447055348

DENTIALHYGIENIST

Hilary Kaye , NP

Nurse Practitioner - Community Health

NPI 1558166983

Nurse Practitioner

NPI 1942353875

Doctor of Chiropractic

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
📍
Updated Practice Location September 13, 2018

Registered at 205 SOUTH ST, FORT BRAGG, CA 954375540 (Tel: 7079614088)

NPI Profile Active July 13, 2016

NPI status registered as active in NPPES database

📍
Updated Practice Location July 13, 2016

Registered at 1 BROOKDALE PLZ, BROOKLYN, NY 112123139 (Tel: 7182406552)

📍
Updated Business Mailing Address July 13, 2016

Registered at 5120 NW 17TH ST, OKLAHOMA CITY, OK 731272858 (Tel: 6787179568)

👤
Provider Name / Credentials Updated July 13, 2016

Recorded as JAE KIM, D.D.S.

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 13, 2016

Student in an Organized Health Care Education/Training Program

🟢
Initial NPI Registration & Enumeration July 13, 2016

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1437501566
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 13, 2016
Last Update: March 07, 2023
Sole Proprietor: Yes

Mailing Address

5120 Nw 17th St

Oklahoma City, OK 731272858

Phone: 6787179568

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.