Active NPI
Taegyun Kim, M.D.
- Internal Medicine Physician
- Flushing, NY
National Provider Identifier
1073772638
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Mar 20, 2022.
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 263541
- Practice address
- 141-47 Northern Blvd.
Suitee #2R
Flushing, NY 11354 - Phone
- (718) 461-2701
- NPI assigned
- Jun 8, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 263541 | NY | Primary |
| Hospitalist Physician | 208M00000X | 235558 | MA |
Addresses
Primary practice location
141-47 Northern Blvd.
Suitee #2R
Flushing, NY 11354
Mailing address
150-38 28TH Ave
Flushing, NY 20748
Phone (301) 318-0507
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 263541 | NY | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Quincy Physician Corporation | Internal Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Critical Care Medicine (Anesthesiology) Physician
- Quincy, MA
- NPI 1144426503
Internal Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343606400000",
"number": "1073772638",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150-38 28TH AVE",
"city": "FLUSHING",
"state": "NY",
"postal_code": "20748",
"telephone_number": "301-318-0507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "141-47 NORTHERN BLVD.",
"address_2": "SUITEE #2R",
"city": "FLUSHING",
"state": "NY",
"postal_code": "11354",
"telephone_number": "718-461-2701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "TAEGYUN",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-08",
"last_updated": "2012-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NY",
"license": "263541",
"primary": true
},
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "MA",
"license": "235558",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flushing, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.