Active NPI
Jiyoung Kim, NP
- Primary Care Nurse Practitioner
- Elmhurst, NY
National Provider Identifier
1154104289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Nurse Practitioner
- License
- F349901
- Practice address
- 4010 77TH St Apt N3
Elmhurst, NY 11373-1109 - Phone
- (914) 987-8600
- NPI assigned
- Aug 14, 2023
- 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 |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | F349901 | NY | Primary |
Addresses
Primary practice location
4010 77TH St Apt N3
Elmhurst, NY 11373-1109
Mailing address
4010 77TH St Apt N3
Elmhurst, NY 11373-1109
Phone (914) 987-8600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F349901 | NY | MD | Primary Care Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1691971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691971200000",
"number": "1154104289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4010 77TH ST APT N3",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113731109",
"telephone_number": "914-987-8600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4010 77TH ST APT N3",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113731109",
"telephone_number": "914-987-8600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JIYOUNG",
"name_prefix": "Ms.",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-14",
"last_updated": "2023-08-14",
"certification_date": "2023-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "363LP2300X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Primary Care",
"state": "NY",
"license": "F349901",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elmhurst, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; 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.