Individual provider Active NPI

Claudia Kim, MD

  • Pediatrics Physician
  • Hawthorne, NJ
National Provider Identifier
1023205135
Registry record updated Mar 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
25MA08813800 Issued in NJ
Practice address
330 Lafayette Ave
Hawthorne, NJ 07506-2506
Phone
(973) 841-5112
Fax
(973) 826-5064
NPI assigned
Oct 2, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 28, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X 25MA08813800 NJ Primary

Addresses

Primary practice location

330 Lafayette Ave
Hawthorne, NJ 07506-2506

Mailing address

330 Lafayette Ave
Hawthorne, NJ 07506-2506
Phone (973) 841-5112

Other identifiers 1

IdentifierTypeStateIssuer
0264423MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20110630000200 NJ Practitioner - Pediatric Medicine 9931387529 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA08813800NJMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph's Healthcare, Inc. CurrentSince May 14, 2011 Accepting new patients
St Josephs University Medical Center Inc. Past Accepting new patients
Hawthorne Pediatrics, LLC Past Accepting new patients

Locations

330 Lafayette Ave
Hawthorne, NJ 07506
Phone (973) 389-5280

703 Main St
Bldg 400
Paterson, NJ 07503
Phone (973) 754-2054

703 Main St
Rm XG2126
Paterson, NJ 07503
Phone (973) 754-2240

703 Main St
Paterson, NJ 07503
Phone (973) 754-2240

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1191283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553731200000",
    "number": "1023205135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 LAFAYETTE AVE",
            "city": "HAWTHORNE",
            "state": "NJ",
            "postal_code": "075062506",
            "telephone_number": "973-841-5112",
            "fax_number": "973-826-5064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 LAFAYETTE AVE",
            "city": "HAWTHORNE",
            "state": "NJ",
            "postal_code": "075062506",
            "telephone_number": "973-841-5112",
            "fax_number": "973-826-5064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "CLAUDIA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-02",
        "last_updated": "2019-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA08813800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0264423",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hawthorne, NJ

Sources for this page

Verify at the official NPI Registry.