Active NPI
Caroline Kim, DDS
- Prosthodontics
- Bronx, NY
National Provider Identifier
1093966517
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 54192
- Practice address
- 55 E Mosholu Pkwy N
Bronx, NY 10467-2625 - Phone
- (718) 652-7370
- NPI assigned
- Oct 2, 2008
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 54192 | NY | Primary |
Addresses
Primary practice location
55 E Mosholu Pkwy N
Bronx, NY 10467-2625
Mailing address
55 E Mosholu Pkwy N
Bronx, NY 10467-2625
Phone (718) 652-7370
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180202000315 | MI | Order and Referring Only - Dentist | 9638439003 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54192 | NY | MD | Prosthodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. Jay Fensterstock DDS P.C. | Prosthodontics | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223942400000",
"number": "1093966517",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 E MOSHOLU PKWY N",
"city": "BRONX",
"state": "NY",
"postal_code": "104672625",
"telephone_number": "718-652-7370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 E MOSHOLU PKWY N",
"city": "BRONX",
"state": "NY",
"postal_code": "104672625",
"telephone_number": "718-652-7370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "CAROLINE",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-02",
"last_updated": "2008-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "NY",
"license": "54192",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.