Haksoo Kim, NURSE PRACTITIONER

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

309261 Issued in NY

Practice address

26 Research Way
East Setauket, NY 11733-3526

Phone

(631) 444-0502

Fax

(631) 444-0187

NPI assigned

Aug 7, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles (6 of 10)

Locations

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989

Interoperability endpoints

• Direct secure messaging: haksoo.kim@direct.stonybrookmedicine.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Stony Brook Internists, University Faculty Practice Corporation

  • Internal Medicine Physician
  • Stony Brook, NY
  • NPI 1821035601
  Medicare reassignment NPD
• Stony Brook Internists, University Faculty Practice Corporation

  • Nephrology Physician
  • Stony Brook, NY
  • NPI 1215976337
  NPD
• Stony Brook Internists, University Faculty Practice Corporation

  • Cardiac Rehabilitation Registered Nurse
  • Stony Brook, NY
  • NPI 1295778371
  NPD
• Stony Brook Internists, University Faculty Practice Corporation

  • Infectious Disease Physician
  • Stony Brook, NY
  • NPI 1497794077
  NPD
• University Hospital at Stony Brook

  • General Acute Care Hospital
  • Stony Brook, NY
  • NPI 1972523348
  NPD
• Stony Brook Internists, University Faculty Practice Corporation

  • Medical Oncology Physician
  • Stony Brook, NY
  • NPI 1184679342
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769126400000",
    "number": "1013562891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 NICOLLS RD",
            "address_2": "HSC, LEVEL 16, RM 80",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117948166",
            "telephone_number": "631-444-1617",
            "fax_number": "631-546-7004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 RESEARCH WAY",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117333526",
            "telephone_number": "631-444-0502",
            "fax_number": "631-444-0187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "HAKSOO",
        "name_prefix": "Ms.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-07",
        "last_updated": "2026-01-23",
        "certification_date": "2026-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "309261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fazel A Khan, M.D.
• Moazzam Khan, MD
• Mohammed Salim Khan, RPH
• Asim S Khokhar, M.D.
• Tammie Kienzle
• Sung Kwang Kim
• Mariam M Kirvalidze, DO
• Jaclyn Kischkower, NP
• Kim Kjaer
• Diane Klein-Ritter, M.D.

• Adult Health Nurse Practitioner in East Setauket, NY
• Providers in East Setauket, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.