Individual provider Active NPI

David Hoi Kim, MD

  • Family Medicine Physician
  • Staten Island, NY
National Provider Identifier
1013981331
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
215860 Issued in NY
Practice address
2079 Forest Ave
Staten Island, NY 10303-1735
Phone
(718) 815-6560
NPI assigned
Feb 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 215860 NY Primary

Addresses

Primary practice location

2079 Forest Ave
Staten Island, NY 10303-1735

Mailing address

2079 Forest Ave
Staten Island, NY 10303-1735
Phone (718) 815-6560

Other identifiers 1

IdentifierTypeStateIssuer
02200604MedicaidNY

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040427000634 NY Practitioner - Internal MedicinePractitioner - Pediatric Medicine 3971590597 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
State University of New York Downstate Medical Center, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2079 Forest Ave
Staten Island, NY 10303-1735
Phone (718) 815-6560

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Christian Community Health Center, Inc. Family Medicine CurrentSince Mar 2, 2011 Accepting new patients
Beacon Christian Community Health Center Inc CurrentSince Apr 1, 2007 Accepting new patients
Richmond Medical Center Past Accepting new patients
Staten Island University Hospital Past Accepting new patients

Locations

2031 Forest Ave
Staten Island, NY 10303
Phone (718) 815-6560

475 Seaview Ave
Staten Island, NY 10305
Phone (718) 226-8855

2079 Forest Ave
Staten Island, NY 10303
Phone (718) 815-6560

Networks

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

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20119/brand/1/csg/1/fhir/r4
  • Direct secure messaging: dkim66237@northwell.direct-ci.com
  • Direct secure messaging: david.kim.1@20119.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Beacon Christian Community Health Center IncStaten Island, NY, CCN 331969 Federally qualified health center Corporate Director (100%) Aug 8, 2006
Beacon Christian Community Health Center IncStaten Island, NY, CCN 571057 Federally qualified health center Corporate Director (100%) Apr 1, 2007

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013981331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2079 FOREST AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103031735",
            "telephone_number": "718-815-6560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2079 FOREST AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103031735",
            "telephone_number": "718-815-6560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "DAVID",
        "middle_name": "HOI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "215860",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02200604",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.