DR. JAEWON KIM
NPI 1558032995
Dentist - Periodontics in Oklahoma City, OK
About Dr. Jaewon Kim NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. JAEWON KIM (NPI 1558032995) is an individual periodontics provider in Oklahoma City, Oklahoma, licensed in Oklahoma (F-021) and active in the NPI registry since September 2021. He has opted out of Medicare through May 14, 2028 and remains eligible to order and refer.
NPPES Registry Identity
Specialties & Licenses
Accepted 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
Dr. Jaewon Kim 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 May 14, 2026 through May 14, 2028.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 73117 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Jaewon Kim's NPI number?
The NPI number for Jaewon Kim is 1558032995. It was assigned to this individual provider in the NPPES registry on September 24, 2021.
Where is Jaewon Kim located?
Jaewon Kim practices at 1201 N Stonewall Ave # 524D, Oklahoma City, OK 73117. The listed phone number is (405) 271-7020.
What is Jaewon Kim's specialty?
The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.
Is Jaewon Kim enrolled in Medicare?
No. Jaewon Kim has opted out of Medicare through May 14, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.
What insurance does Jaewon Kim accept?
Health plans from Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Guardian list Jaewon Kim 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 Jaewon Kim was last updated on September 24, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Dr. Jaewon Kim · NPI 1558032995
Periodontics provider in Oklahoma City, Oklahoma. Individual provider, active in the CMS NPPES registry since September 24, 2021.
## Identity
- **NPI:** 1558032995 (Entity type: Individual)
- **Enumerated:** September 24, 2021
- **Primary specialty:** Dentist - Periodontics · taxonomy 1223P0300X
- **State license:** F-021 (Oklahoma)
- **Sole proprietor:** No
## Practice location
- **Address:** 1201 N STONEWALL AVE # 524D, Oklahoma City, OK 73117-1214
- **Phone:** (405) 271-7020
## Medicare
- **Medicare:** Opted out of Medicare (opt-out affidavit on file, in effect through May 14, 2028); services are provided under private contract
## Record status
- **NPPES last updated:** September 24, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1558032995) · Data from the CMS NPPES public registry.