Active NPI
Sang H Kim
- Pharmacist
- Port Jefferson Station, NY
National Provider Identifier
1003378704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 064957
- Practice address
- 1110 Route 112
Port Jefferson Station, NY 11776-3236 - Phone
- (401) 765-1500
- NPI assigned
- Apr 2, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 064957 | NY | Primary |
Addresses
Primary practice location
1110 Route 112
Port Jefferson Station, NY 11776-3236
Mailing address
1110 Route 112
Port Jefferson Station, NY 11776-3236
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 064957 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554163200000",
"number": "1003378704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1110 ROUTE 112",
"city": "PORT JEFFERSON STATION",
"state": "NY",
"postal_code": "117763236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1110 ROUTE 112",
"city": "PORT JEFFERSON STATION",
"state": "NY",
"postal_code": "117763236",
"telephone_number": "401-765-1500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SANG",
"middle_name": "H",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-02",
"last_updated": "2019-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "064957",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson Station, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.