Active NPI
Jane Kim
- Speech-Language Pathologist
- Whitestone, NY
National Provider Identifier
1174053987
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 027917
- Practice address
- 15050 14TH Rd
Whitestone, NY 11357-2609 - Phone
- (718) 767-0091
- NPI assigned
- Jun 14, 2017
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 027917 | NY | Primary |
Addresses
Primary practice location
15050 14TH Rd
Whitestone, NY 11357-2609
Mailing address
8702 248TH St
Bellerose, NY 11426-2008
Phone (917) 502-7121
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05293105 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 027917 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603065600000",
"number": "1174053987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8702 248TH ST",
"city": "BELLEROSE",
"state": "NY",
"postal_code": "114262008",
"telephone_number": "917-502-7121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15050 14TH RD",
"city": "WHITESTONE",
"state": "NY",
"postal_code": "113572609",
"telephone_number": "718-767-0091"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JANE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-14",
"last_updated": "2020-10-19",
"certification_date": "2020-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "027917",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "05293105",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Whitestone, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.