Roderick Youngdo Kim, DDS, MD is a medicare enrolled "Oral & Maxillofacial Surgery" physician in Fort Worth, Texas. He went to University Of Michigan Medical School and graduated in 2015 and has 11 years of diverse experience with area of expertise as Maxillofacial Surgery. He is a member of the group practice Oral And Maxillofacial Network Pllc and his current practice location is
1500 S Main St Dept Of, Fort Worth, Texas. You can reach out to his office (for appointments etc.) via phone at
(817) 702-6936.
Roderick Youngdo Kim is licensed to practice in Texas (license number 32838) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1689954562.
Physician's Profile
| Full Name | Roderick Youngdo Kim |
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| Gender | Male |
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| Speciality | Maxillofacial Surgery |
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| Experience | 11 Years |
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| Location | 1500 S Main St Dept Of, Fort Worth, Texas |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Roderick Youngdo Kim attended and graduated from University Of Michigan Medical School in 2015
NPI Data:
- NPI Number: 1689954562
- Provider Enumeration Date: 08/23/2011
- Last Update Date: 06/26/2024
Medicare PECOS Information:
- PECOS PAC ID: 5698081347
- Enrollment ID: I20170805000004
Medical Identifiers
Medical identifiers for Roderick Youngdo Kim such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1689954562 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 204E00000X | Oral & Maxillofacial Surgery | 32838 (Texas) | Primary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 32838 (Texas) | Secondary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Oral And Maxillofacial Network Pllc | 2668498387 | 7 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Roderick Youngdo Kim allows following entities to bill medicare on his behalf.
| Entity Name | Oral & Maxillofacial Network PLLC |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1417170655
PECOS PAC ID: 2668498387
Enrollment ID: O20051021000045 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Roderick Youngdo Kim is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Roderick Youngdo Kim, DDS, MD
1500 South Main, Department Of Omfs,
Fort Worth, TX 76104
Ph: Not Available | Roderick Youngdo Kim, DDS, MD
1500 S Main St Dept Of,
Fort Worth, TX 76104-4917
Ph: (817) 702-6936 |
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