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DR. SANG YOON KIM DMD, MD
NPI 1992826333
Oral & Maxillofacial Surgery in Vienna, VA

Active since April 03, 2007Opted out of Medicare · through Apr 1, 2028
361 MAPLE AVE W, SUITE 200, VIENNA, VA 22180(703) 255-9400(703) 255-4958 Get Directions Write a Review

NPPES record last updated: June 14, 2013. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Sang Yoon Kim Dmd, Md NPPES

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

DR. SANG YOON KIM DMD, MD (NPI 1992826333) is an individual oral & maxillofacial surgery provider in Vienna, Virginia, licensed in Virginia (0101251217) and active in the NPI registry since April 2007. He has opted out of Medicare through April 1, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1992826333
Entity TypeIndividualMale
Primary Taxonomy204E00000X
Provider Legal NameDR. SANG YOON KIMCredential: DMD, MD
Location Address361 MAPLE AVE W, SUITE 200Vienna, VA 22180-4304
Mailing Address361 Maple Ave W, Suite 200Vienna, VA 22180-4304 · (703) 255-9400 · Fax (703) 255-4958
Phone(703) 255-9400
Fax(703) 255-4958
Sole ProprietorYes
Enumeration DateApril 3, 2007
Last NPPES UpdateJune 14, 2013
✔ NPI 1992826333 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 VA · 0101251217
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 0401413454 (VA)
361 MAPLE AVE W, Vienna, VA 22180
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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. Sang Yoon Kim Dmd, Md 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 April 1, 2014 through April 1, 2028.

Opt-Out Effective DateApril 1, 2014
Opt-Out In Effect ThroughApril 1, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES 2

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

DR. CHRISTOPHER E BONACCI D.D.S., M.D.
Dentist (Oral and Maxillofacial Surgery)
361 MAPLE AVE W
VIENNA, VA 22180
Fairfax County (703) 255-9400
CHRISTOPHER E. BONACCI DDS MD PC
Clinic/Center (Oral and Maxillofacial Surgery)
361 MAPLE AVE W, SUITE 200
VIENNA, VA 22180
Fairfax County (703) 255-9400

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 Sang Kim's NPI number?

The NPI number for Sang Kim is 1992826333. It was assigned to this individual provider in the NPPES registry on April 3, 2007.

Where is Sang Kim located?

Sang Kim practices at 361 Maple Ave W Suite 200, Vienna, VA 22180. The listed phone number is (703) 255-9400.

What is Sang Kim's specialty?

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

Is Sang Kim enrolled in Medicare?

No. Sang Kim has opted out of Medicare through April 1, 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.

When was this NPI record last updated?

The NPPES record for Sang Kim was last updated on June 14, 2013. NPI Profile syncs with the weekly NPPES data releases published by CMS.