NPIMap

Organization Active NPI

Daniel Y. Kim, M.D., P.a.

  • Ophthalmology Physician
  • Palisades Park, NJ
National Provider Identifier
1073582805
Registry record updated Aug 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
MA65006 Issued in NJ
Legal business name
DANIEL Y. KIM, M.D., P.A.
Practice address
540 Bergen Blvd
Palisades Park, NJ 07650-2322
Phone
(201) 461-3970
Fax
(201) 242-9061
NPI assigned
Mar 15, 2006
Last updated
Aug 1, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2012

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

Authorized official

Name
Lena Kim
Title
Billing
Phone
(201) 461-3970

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X MA65006 NJ Primary

Addresses

Primary practice location

540 Bergen Blvd
Palisades Park, NJ 07650-2322

Mailing address

540 Bergen Blvd
Palisades Park, NJ 07650-2322
Phone (201) 461-3970

Other identifiers 9

IdentifierTypeStateIssuer
976044OtherNJEMPIREBCBS
160591OtherNJNEW ENGLAND ONE HEALTH
1106389OtherNJFIRST HEALTH
1537021OtherNJUNITED HEALTHCARE
180036662OtherNJRAILROAD MEDICARE
OK4450OtherNJHEALTHNET
976044OtherCTCIGNA
2033258OtherNJAETNA
P672617OtherNJOXFORD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040928000749 NJ Part B Supplier - Clinic/Group Practice 8628047545 Receives reassigned benefits from 6 practitioners
Practice locations: Palisades Park, NJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343779200000",
    "number": "1073582805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 BERGEN BLVD",
            "city": "PALISADES PARK",
            "state": "NJ",
            "postal_code": "076502322",
            "telephone_number": "201-461-3970",
            "fax_number": "201-242-9061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 BERGEN BLVD",
            "city": "PALISADES PARK",
            "state": "NJ",
            "postal_code": "076502322",
            "telephone_number": "201-461-3970",
            "fax_number": "201-242-9061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DANIEL Y. KIM, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-15",
        "last_updated": "2012-08-01",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "LENA",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "201-461-3970"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NJ",
            "license": "MA65006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIREBCBS",
            "identifier": "976044",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW ENGLAND ONE HEALTH",
            "identifier": "160591",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "1106389",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1537021",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "180036662",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "OK4450",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "976044",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2033258",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P672617",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palisades Park, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.