Individual provider Active NPI

Randie Kim, MD, PHD

  • Dermatology Physician
  • New York, NY
National Provider Identifier
1104059773
Registry record updated Jan 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
275296 Issued in NY
Practice address
550 First Avenue
NYU Langone Medical Center
New York, NY 10016
Phone
(212) 263-5506
NPI assigned
Aug 31, 2009
Last updated
Jan 3, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 275296 NY Primary
Dermatopathology (Pathology) Physician 207ZD0900X 275296 NY

Addresses

Primary practice location

550 First Avenue
NYU Langone Medical Center
New York, NY 10016

Mailing address

550 First Avenue
NYU Langone Medical Center
New York, NY 10016
Phone (212) 263-5506

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
I20160706001963 NY Practitioner - Dermatology 9931491206 Reassigns benefits to 4 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
275296NYMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai CurrentSince Apr 1, 2023 Accepting new patients
New York University CurrentSince Aug 1, 2016 Accepting new patients
New York University CurrentSince Aug 1, 2016 Accepting new patients
Fpa Hospital Based Current Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Oct 1, 2022 Accepting new patients
Fpa Hospital Based Dermatopathology CurrentSince Nov 1, 2022 Accepting new patients
Icahn School of Medicine at Mount Sinai Dermatology CurrentSince Oct 1, 2022 Accepting new patients
Fpa Hospital Based Current Accepting new patients

Locations

1468 Madison Ave
New York, NY 10029
Phone (212) 241-0440

1468 Madison Ave
#308
New York, NY 10029

5 E 98th St
Fl 5
New York, NY 10029
Phone (212) 241-8234

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

550 1st Ave
New York, NY 10016
Phone (212) 263-3293

Networks

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

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1251676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483401600000",
    "number": "1104059773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 FIRST AVENUE",
            "address_2": "NYU LANGONE MEDICAL CENTER",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10016",
            "telephone_number": "212-263-5506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 FIRST AVENUE",
            "address_2": "NYU LANGONE MEDICAL CENTER",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10016",
            "telephone_number": "212-263-5506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "RANDIE",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-31",
        "last_updated": "2017-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "275296",
            "primary": true
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "NY",
            "license": "275296",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.