RODERICK YOUNGDO KIM DDS MD NPI 1689954562

NPI Information

  • NPI: 1689954562
  • Provider Name: RODERICK YOUNGDO KIM, DDS, MD
  • Classification: Oral & Maxillofacial Surgery - 204E00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1500 S MAIN ST DEPT OF
    FORT WORTH, TX
    ZIP 76104
  • Phone: (817) 702-6936

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NPI Details

Roderick Youngdo Kim, DDS, MD is an oral maxillofacial surgery in Fort Worth, TX with 11 years of experience. The provider is 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. Roderick Youngdo Kim, DDS, MD NPI is 1689954562. The provider is registered as an individual entity type and is a single specialty group.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF MICHIGAN MEDICAL SCHOOL
Graduation Year:2015

The provider's business location address is:

1500 S MAIN ST DEPT OF
FORT WORTH, TX
ZIP 76104-917
Phone: (817) 702-6936

The NPI 1689954562 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/23/2011 and was last updated on 6/26/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1204E00000XOral & Maxillofacial Surgery32838TEXASYes
21223S0112XDentistOral and Maxillofacial Surgery32838TEXASNo

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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