Chong Kim

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

735 Attucks LN
Hyannis, MA 02601-1867

Phone

(508) 778-5420

NPI assigned

Feb 26, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1614297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614297600000",
    "number": "1104410364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 CHESHIRE CT",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300436514",
            "telephone_number": "678-333-4281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 ATTUCKS LN",
            "city": "HYANNIS",
            "state": "MA",
            "postal_code": "026011867",
            "telephone_number": "508-778-5420"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1135 Morton St",
            "address_purpose": "LOCATION",
            "city": "Mattapan",
            "state": "MA",
            "postal_code": "021262834",
            "country_code": "US",
            "telephone_number": "617-533-2278",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "CHONG",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-02-26",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Frederick J Kerle, LADC 1
• Robert Hugh Kerr, LMHC
• Mary Elizabeth Keyes
• Kids Smiles Inc
• Kathleen Ann Kiely, MSW, LICSW
• Timothy J Kinkead, MD
• Gayle L Kirk, MSW
• Heidi Kirwan, LCSW
• Doriann Klaassen, MD
• Iris S. Klarer

• All providers in Hyannis, MA
• Student in an Organized Health Care Education/Training Program in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.