Individual provider Active NPI

Soo Yeon Kim, M.D.

  • Interventional Pain Medicine Physician
  • New York, NY
National Provider Identifier
1073868899
Registry record updated Feb 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
265871 Issued in NY
Practice address
10 Union SQ E # 5P
New York, NY 10003-3314
Phone
(122) 241-6321
Fax
(646) 537-1468
NPI assigned
Jul 18, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X 265871 NY
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X D87164 MD
Interventional Pain Medicine Physician 208VP0014X 265871 NY Primary

Addresses

Primary practice location

10 Union SQ E # 5P
New York, NY 10003-3314

Mailing address

10 Union SQ E # 5P
New York, NY 10003-3314
Phone (212) 241-6321

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
I20121017000827 NY Practitioner - Pain ManagementPractitioner - Physical Medicine and Rehabilitation 3173773645 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pain ManagementAlso: Physical Medicine and Rehabilitation
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

10 Union SQ E
New York, NY 10003-3314
Phone (212) 844-8750

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D87164MDMDPain Medicine (Physical Medicine & Rehabilitation) Physician
265871NYMDInterventional Pain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai CurrentSince Aug 10, 2022 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Aug 10, 2022 Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients

Locations

10 Union Sq E
New York, NY 10003
Phone (212) 253-6800

10 Union Sq E
Ste 5P
New York, NY 10003
Phone (212) 844-8618

150 E 42nd St
Fl 2
New York, NY 10017
Phone (646) 605-8119

5 E 98th St
Fl 6
New York, NY 10029
Phone (212) 241-2221

10 Union Sq E
#5P
New York, NY 10003
Phone (212) 844-8680

Networks

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

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.

Hospital & facility affiliations 5

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": "1342569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677456000000",
    "number": "1073868899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 UNION SQ E # 5P",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100033314",
            "telephone_number": "212-241-6321",
            "fax_number": "646-537-1468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 UNION SQ E # 5P",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100033314",
            "telephone_number": "122-241-6321",
            "fax_number": "646-537-1468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SOO YEON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-18",
        "last_updated": "2023-02-27",
        "certification_date": "2023-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "NY",
            "license": "265871",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "MD",
            "license": "D87164",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NY",
            "license": "265871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.