RODERICK YOUNGDO KIM DDS, MD
NPI 1689954562
Oral & Maxillofacial Surgery in Fort Worth, TX

Active since August 23, 2011PECOS EnrolledAccepts Medicare Assignment
1500 S MAIN ST DEPT OF, FORT WORTH, TX 76104(817) 702-6936 Get Directions Write a Review

NPPES record last updated: June 26, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jun 26, 2024, Jul 6, 2017, Jun 29, 2017 (3 updates tracked since 2017).

About Roderick Youngdo Kim Dds, Md NPPES

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

RODERICK YOUNGDO KIM DDS, MD (NPI 1689954562) is an individual oral & maxillofacial surgery provider in Fort Worth, Texas, licensed in Texas (32838) and active in the NPI registry since August 2011. He is enrolled in Medicare PECOS, is affiliated with Jps Health Network, and is a graduate of University Of Michigan Medical School (2015).

NPPES Registry Identity

NPI1689954562
Entity TypeIndividualMale
Primary Taxonomy204E00000X
Provider Legal NameRODERICK YOUNGDO KIMCredential: DDS, MD
Location Address1500 S MAIN ST DEPT OFFort Worth, TX 76104-4917
Mailing Address1500 South Main, Department Of OmfsFort Worth, TX 76104
Sole ProprietorYes
Medical School CMSUniversity Of Michigan Medical SchoolGraduated 2015
Enumeration DateAugust 23, 2011
Last NPPES UpdateJune 26, 20243 updates tracked since enumeration
NPPES CertifiedJune 26, 2024
NPI 1689954562 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyOral & Maxillofacial SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code204E00000X
License Licensed in TX · 32838
Definition

Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery.

Also ListedDentist · Oral and Maxillofacial SurgeryTaxonomy 1223S0112X · License 32838 (TX)
1500 S MAIN ST DEPT OF, Fort Worth, TX 76104

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Roderick Youngdo Kim Dds, Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5698081347
PECOS Enrollment IDI20170805000004
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Jps Health Network

Acute Care Hospitals · Fort Worth, TX
3/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number450039
Location1500 S Main StFort Worth, TX 76104 · Tarrant County
Emergency services Birthing friendly

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 Roderick Kim's NPI number?

The NPI number for Roderick Kim is 1689954562. It was assigned to this individual provider in the NPPES registry on August 23, 2011.

Where is Roderick Kim located?

Roderick Kim practices at 1500 S Main St Dept Of, Fort Worth, TX 76104. The listed phone number is (817) 702-6936.

What is Roderick Kim's specialty?

The primary specialty registered for this NPI is Oral & Maxillofacial Surgery with taxonomy code 204E00000X.

Is Roderick Kim enrolled in Medicare?

Yes. Roderick Kim is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Roderick Kim accept?

Health plans from Ambetter Health, Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and Ambetter from Superior HealthPlan and 17 other insurers list Roderick 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.

Is Roderick Kim affiliated with any hospitals?

According to CMS data, Roderick Kim is affiliated with Jps Health Network.

When was this NPI record last updated?

The NPPES record for Roderick Kim was last updated on June 26, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.