Individual provider Active NPI

Mee Kyung Kim, D.C.

  • Chiropractor
  • Elkins Park, PA
National Provider Identifier
1104896216
Registry record updated Aug 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
38MC00631100 Issued in NJ
Practice address
7320 Old York Rd Ste 207a
Elkins Park, PA 19027-3007
Phone
(215) 500-2000
Fax
(888) 778-8180
NPI assigned
Jan 23, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 8, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X 25MZ00173100 NJ
Chiropractor 111N00000X 38MC00631100 NJ Primary
Chiropractor 111N00000X DC009262 PA

Addresses

Primary practice location

7320 Old York Rd Ste 207a
Elkins Park, PA 19027-3007

Mailing address

804 Pleasant Valley Ave
Mount Laurel, NJ 08054-1222
Phone (215) 500-2000

Other identifiers 3

IdentifierTypeStateIssuer
38MC00631100OtherNJDC LICENSE
DC009262OtherPADC LICENSE
25MZ00173100OtherNJLAC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081031000500 NJ Practitioner - Chiropractic 2668406786

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
25MZ00173100NJMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Lusky Corp Chiropractor CurrentSince Jun 14, 2024 Accepting new patients
Rapa Care, Inc Chiropractor CurrentSince Aug 11, 2024 Accepting new patients
Sportsmed PT LLC Chiropractor PastSince Nov 8, 2021 Accepting new patients

Locations

1600 Parker Ave
Ste 1
Fort Lee, NJ 07024
Phone (201) 302-9993

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.

NPI Registry JSON

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1104896216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 PLEASANT VALLEY AVE",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080541222",
            "telephone_number": "215-500-2000",
            "fax_number": "215-500-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7320 OLD YORK RD STE 207A",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190273007",
            "telephone_number": "215-500-2000",
            "fax_number": "888-778-8180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MEE KYUNG",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-23",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NJ",
            "license": "25MZ00173100",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "38MC00631100",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC009262",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DC LICENSE",
            "identifier": "38MC00631100",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DC LICENSE",
            "identifier": "DC009262",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LAC",
            "identifier": "25MZ00173100",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkins Park, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.