Active NPI
Jin Suk Calvin Kim, MD
- Otolaryngology Physician
- New York, NY
National Provider Identifier
1093071730
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 130574
- Practice address
- 622 West 168TH Street
New York, NY 10032 - Phone
- (212) 305-6081
- NPI assigned
- Apr 6, 2012
- Last updated
- Jul 20, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 130574 | CA | Primary |
Addresses
Primary practice location
622 West 168TH Street
New York, NY 10032
Mailing address
180 Fort Washington Ave
RM. HP 8-814
New York, NY 10032-3722
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 130574 | CA | MD | Otolaryngology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Assured Imaging Womens Wellness of Southern Arizona LLC | Past | Accepting new patients | |
| Alinea Imaging Associates Inc | Past | Accepting new patients | |
| Marque Medical Clinic, Inc. | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Alinea Medical Imaging
- Mobile Mammography Clinic/Center
- Pomona, CA
- NPI 1376884221
-
dba Assured Imaging Women's Wellness
- Diagnostic Radiology Physician
- Tucson, AZ
- NPI 1043021298
-
dba Marque Urgent Care
- Urgent Care Clinic/Center
- Buena Park, CA
- NPI 1841825841
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1333670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468972800000",
"number": "1093071730",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "180 FORT WASHINGTON AVE",
"address_2": "RM. HP 8-814",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100323722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "622 WEST 168TH STREET",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10032",
"telephone_number": "212-305-6081"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JIN SUK",
"middle_name": "CALVIN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-04-06",
"last_updated": "2016-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "CA",
"license": "130574",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.