Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ji Won Kim

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1164004206

Ji Won Kim is a Student in an Organized Health Care Education/Training Program in Springfield, Massachusetts. Practices as a sole proprietor. Licensed in Massachusetts and New York.

Licensed in
MA, NY
In the registry since
2021
Specialties on file
2

Practice location Address checks out

555 State St
Springfield, MA 01109-4140
Phone: (312) 768-0965
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence DN1859098 (MA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X (NY)

Record details

NPI number1164004206
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedApril 27, 2021
Last updated in NPPESJuly 21, 2021
Certification dateJune 2, 2021
Mailing address350 N Clark St Ste 600, Chicago, IL 60654-4782

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