KYUNG NAM DDS
NPI 1548934615
Dentist - Periodontics in San Jose, CA

Q: What is Kyung Nam's NPI number?

The NPI number for Kyung Nam is 1548934615. It was assigned to this individual provider in the NPPES registry on August 3, 2021.

Q: What is Kyung Nam's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

Q: Is Kyung Nam enrolled in Medicare?

No. Kyung Nam has opted out of Medicare through October 4, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Kyung Nam was last updated on August 3, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since August 03, 2021Opted out of Medicare · through Oct 4, 2027

6701 EDGEMOOR WAY, SAN JOSE, CA 95129(408) 464-1912 Get Directions Write a Review

NPPES record last updated: August 3, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Kyung Nam Dds NPPES

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

KYUNG NAM DDS (NPI 1548934615) is an individual periodontics provider in San Jose, California, licensed in California (106717) and active in the NPI registry since August 2021. He has opted out of Medicare through October 4, 2027.

NPPES Registry Identity

NPI1548934615

Entity TypeIndividualMale

Primary Taxonomy1223P0300X

Provider Legal NameKYUNG NAMCredential: DDS

Location Address6701 EDGEMOOR WAYSan Jose, CA 95129-2933

Mailing Address6701 Edgemoor WaySan Jose, CA 95129-2933

Phone(408) 464-1912

Sole ProprietorNo

Enumeration DateAugust 3, 2021

NPPES CertifiedAugust 3, 2021

✔ NPI 1548934615 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · PeriodonticsDental Providers

Taxonomy Code1223P0300X

License✔ Licensed in CA · 106717

Definition

That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.

6701 EDGEMOOR WAY, San Jose, CA 95129

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Kyung Nam Dds has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from October 4, 2021 through October 4, 2027.

Opt-Out Effective DateOctober 4, 2021

Opt-Out In Effect ThroughOctober 4, 2027Opt-out affidavits renew automatically every two years unless cancelled

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 Kyung Nam's NPI number?

The NPI number for Kyung Nam is 1548934615. It was assigned to this individual provider in the NPPES registry on August 3, 2021.

Where is Kyung Nam located?

Kyung Nam practices at 6701 Edgemoor Way, San Jose, CA 95129. The listed phone number is (408) 464-1912.

What is Kyung Nam's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

Is Kyung Nam enrolled in Medicare?

No. Kyung Nam has opted out of Medicare through October 4, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

What insurance does Kyung Nam accept?

Health plans from Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 6 other insurers list Kyung Nam as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kyung Nam was last updated on August 3, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.