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JAE DO KIM D.D.S.
NPI 1437501566
Dentist - General Practice in Fort Bragg, CA

Active since July 13, 2016
205 SOUTH ST, FORT BRAGG, CA 95437(707) 961-4088 Get Directions Write a Review

NPPES record last updated: March 7, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Mar 7, 2023, Sep 13, 2018, Jul 13, 2016 (3 updates tracked since 2016).

About Jae Do Kim D.d.s. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JAE DO KIM D.D.S. (NPI 1437501566) is an individual general practice provider in Fort Bragg, California, licensed in California (102969) and active in the NPI registry since July 2016. He maintains a secondary practice location in Brooklyn.

NPPES Registry Identity

NPI1437501566
Entity TypeIndividualMale
Primary Taxonomy1223G0001X
Provider Legal NameJAE DO KIMCredential: D.D.S.
Location Address205 SOUTH STFort Bragg, CA 95437-5540
Mailing Address5120 Nw 17th StOklahoma City, OK 73127-2858 · (678) 717-9568
Phone(707) 961-4088
Sole ProprietorYes
Enumeration DateJuly 13, 2016
Last NPPES UpdateMarch 7, 20233 updates tracked since enumeration
✔ NPI 1437501566 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in CA · 102969
Definition

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.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
205 SOUTH ST, Fort Bragg, CA 95437
Open in Google Maps ↗

Secondary Practice Location 1

Location 11 Brookdale PlzBrooklyn, NY 11212-3139 · Phone (718) 240-6552 · Fax (718) 240-6682

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. WADE JOSEPH GRAY MD
Family Medicine
205 SOUTH ST
FORT BRAGG, CA 95437
Mendocino County (707) 964-1251
JOHN T WALLACE II MD
Internal Medicine
205 SOUTH ST
FORT BRAGG, CA 95437
Mendocino County (707) 964-1251
LAWRENCE M GOLDYN M.D.
Family Medicine (Adult Medicine)
205 SOUTH ST
FORT BRAGG, CA 95437
Mendocino County (707) 964-1251
FRANK BEN HOUSEL III MD
Family Medicine
205 SOUTH ST
FORT BRAGG, CA 95437
Mendocino County (707) 964-1251
MR. RICHARD WILLIAM JAULUS LCSW
Social Worker (Clinical)
205 SOUTH ST
FORT BRAGG, CA 95437
Mendocino County (707) 964-1251
MS. DAWN BARBARA HOFBERG PA
Physician Assistant
205 SOUTH ST
FORT BRAGG, CA 95437
Mendocino County (707) 964-1251
MS. MARCIA ANN ASTIER RDH
Dental Hygienist
205 SOUTH ST
FORT BRAGG, CA 95437
Mendocino County (707) 964-1251
DR. TADEUS ULATOWSKI DDS
Dentist
205 SOUTH ST
FORT BRAGG, CA 95437
Mendocino County (707) 964-1251

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jae Kim's NPI number?

The NPI number for Jae Kim is 1437501566. It was assigned to this individual provider in the NPPES registry on July 13, 2016.

Where is Jae Kim located?

Jae Kim practices at 205 South St, Fort Bragg, CA 95437. The listed phone number is (707) 961-4088.

What is Jae Kim's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Jae Kim was last updated on March 7, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.