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Deactivated NPI 1679694293 Deactivated / Inactive NPI Male Practitioner

Dr. Dong Won Kim , DMD

Dentist • Lowell, MA

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Dong Kim has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date April 02, 2007
NPI Deactivation Date November 07, 2019
Total Practice Duration ~12 Years of Practice (2007 – 2019)

Professional Overview & Biography Verified Profile Summary

Dr. Dong Kim, DMD was a registered Dentist practicing in Lowell, MA. Throughout an active medical career spanning 12 years, Dr. Kim provided care at the practice location at 133 MARKET ST until profile deactivation on 2019-11-07.

Practice Location & Contact Primary Location

Practice Address

133 Market St

Lowell, MA 018521808

Telephone 9784581179
Fax 9788051415
Associated Practice Facility / Clinic
🏢 Iham Gammas Dmd Llc Facility NPI 1437658226

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist in Lowell, MA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 18.4 Yrs
Regional Practice Density
33 Specialists

Practicing in Lowell, MA (3030 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

CMS Verified: 2023-01-26
Dentist Primary Specialty

NUCC Taxonomy Code: 122300000X

State License MA 21536

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
0207110 (MA)

Practice Associates & Co-Workers

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

4 Associated Practitioners
Dr. Sonali Lahoti , DDS

Dentist - General Practice

NPI 1376930172

Doctor of Dental Surgery

Dr. Konstantin Amirzadov , DMD

Dentist - General Practice

NPI 1598891020

Doctor of Dental Medicine

NPI 1750270757

Doctor of Dental Medicine

Dr. Samuel Hsieh , DMD

Dentist - General Practice

NPI 1811163850

Doctor of Dental Medicine

Career & Practice History Timeline

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

11 Historical Events
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Updated Practice Location November 19, 2019

Registered at 133 MARKET ST, LOWELL, MA 018521808 (Tel: 9784581179)

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Updated Business Mailing Address November 19, 2019

Registered at 3600 MYSTIC VALLEY PKWY, APT # 709, MEDFORD, MA 021555733 (Tel: 7813934830)

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Provider Name / Credentials Updated November 19, 2019

Recorded as DONG KIM, D.M.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) November 19, 2019

Dentist (License #21536 in MA)

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NPI Profile Deactivated November 07, 2019

Record deactivated on November 07, 2019

NPI Profile Active July 09, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 09, 2007

Registered at 133 MARKET ST, LOWELL, MA 018521808 (Tel: 9784581179)

📍
Updated Business Mailing Address July 09, 2007

Registered at 3600 MYSTIC VALLEY PKWY, APT # 709, MEDFORD, MA 021555733 (Tel: 7813934830)

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Provider Name / Credentials Updated July 09, 2007

Recorded as DONG KIM, D.M.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 09, 2007

Dentist (License #21536 in MA)

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Initial NPI Registration & Enumeration April 02, 2007

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: 1679694293
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: April 02, 2007
Last Update: January 26, 2023
Deactivation Date: November 07, 2019
Sole Proprietor: Yes

Mailing Address

3600 Mystic Valley Pkwy, Apt # 709

Medford, MA 021555733

Phone: 7813934830

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.