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Active NPI 1104174168 Individual Practitioner Female Practitioner

Dr. Elly Bunsun Kim , DDS

Dentist - General Practice • Albuquerque, NM

Professional Overview & Biography Verified Profile Summary

Dr. Elly Kim, DDS is a registered healthcare professional specializing in Dentist - General Practice in Albuquerque, NM. Practice services are available at 4201 CENTRAL AVE NW under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

4201 Central Ave Nw

Albuquerque, NM 871051630

Telephone 5058437172
Associated Practice Facility / Clinic
🏢 Milagro Physical Therapy, Llc Facility NPI 1427280767

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Albuquerque, NM

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 17.5 Yrs
State Avg: 9.6 Yrs
Regional Practice Density
306 Specialists

Practicing in Albuquerque, NM (761 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 NM DD3755

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.

Practice Associates & Co-Workers

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

8 Associated Practitioners
Dr. David Opack , DDS

Dentist - General Practice

NPI 1104231752

Doctor of Dental Surgery

NPI 1144920349

Doctor of Dental Surgery

Eirene Ding

Student in an Organized Health Care Education/Training Program

NPI 1316884570
Dr. Thao Pham , DMD

Dentist - General Practice

NPI 1457976060

Doctor of Dental Medicine

NPI 1558060343
Dr. Jae Yang , DDS

Dentist - General Practice

NPI 1629417902

Doctor of Dental Surgery

Career & Practice History Timeline

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

6 Historical Events
NPI Profile Active August 24, 2012

NPI status registered as active in NPPES database

📍
Updated Practice Location August 24, 2012

Registered at 4201 CENTRAL AVE NW, ALBUQUERQUE, NM 871051630 (Tel: 5058437172)

📍
Updated Business Mailing Address August 24, 2012

Registered at 4201 CENTRAL AVE NW, ALBUQUERQUE, NM 871051630

👤
Provider Name / Credentials Updated August 24, 2012

Recorded as ELLY KIM, D.D.S.

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 24, 2012

Dentist (License #DD3755 in NM)

🟢
Initial NPI Registration & Enumeration August 24, 2012

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: 1104174168
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 24, 2012
Last Update: August 24, 2012
Sole Proprietor: No

Mailing Address

4201 Central Ave Nw

Albuquerque, NM 871051630

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.