Individual provider Active NPI

Yesul Kim, MD

  • Dermatology Physician
  • Fairfield, CT
National Provider Identifier
1144725672
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
74023 Issued in CT
Practice address
1305 Post Rd Ste 310
Fairfield, CT 06824-6016
Phone
(203) 259-7709
Fax
(203) 259-7709
NPI assigned
Mar 27, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 74023 CT Primary

Addresses

Primary practice location

1305 Post Rd Ste 310
Fairfield, CT 06824-6016

Mailing address

1 Cooper PLZ
Camden, NJ 08103-1461

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20230518003410 CT Practitioner - Dermatology 0143566653 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Pennsylvania State University College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairfield Dermatology P.C.Group PAC ID 9234201716, 10 clinicians

Practice addresses (Care Compare)

1305 Post Rd
Suite 310
Fairfield, CT 06824-6016
Phone (203) 259-7709

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision107
Removal of skin lesions249
Removal of skin cancer430
Removal or shaving of skin growth1-10
Skin biopsy136

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairfield Dermatology, P.C. CurrentSince Jul 1, 2023 Accepting new patients

Locations

1305 Post Rd
Ste 310
Fairfield, CT 06824
Phone (203) 259-7709

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": "1522108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714348800000",
    "number": "1144725672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 COOPER PLZ",
            "city": "CAMDEN",
            "state": "NJ",
            "postal_code": "081031461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 POST RD STE 310",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068246016",
            "telephone_number": "203-259-7709",
            "fax_number": "203-259-7709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "YESUL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-27",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CT",
            "license": "74023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, CT

Sources for this page

Verify at the official NPI Registry.