NPIMap

Individual provider Active NPI

Stanley Kim, M.D.

  • Specialist
  • Edison, NJ
National Provider Identifier
1306850433
Registry record updated Jun 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MA64078 Issued in NJ
Practice address
34 Progress St # 36
Suite A7
Edison, NJ 08820-1103
Phone
(908) 769-1440
NPI assigned
Jul 27, 2006
Last updated
Jun 2, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X MA64078 NJ Primary

Addresses

Primary practice location

34 Progress St # 36
Suite A7
Edison, NJ 08820-1103

Mailing address

34-36 Progress Street
Suite A7
Edison, NJ 08820
Phone (908) 769-1440

Other identifiers 1

IdentifierTypeStateIssuer
7879601MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050622000312 NJ Practitioner - NephrologyPractitioner - Internal Medicine 4789629627 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

34 -36 Progress St
Suite A7
Edison, NJ 08820-1197
Phone (908) 769-1440

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA64078NJMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Edison Nephrorlogy Consultants Specialist CurrentSince Jun 10, 1999 Accepting new patients
Diagnostic Ultrasound Plus Inc Past Accepting new patients
RN USA LLC Specialist PastSince Dec 15, 2005 Accepting new patients
Medical Associates of Englewood, PC PastSince Jan 29, 2018 Accepting new patients
A Sulse M. D. Prof Assoc Specialist Past Accepting new patients

Locations

34-36 Progress St
Ste A7
Edison, NJ 08820
Phone (908) 769-1440

36 Progress St
Ste A7
Edison, NJ 08820
Phone (732) 669-0077

2182 Lemoine Ave
Ste 1
Fort Lee, NJ 07024
Phone (201) 461-5900

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212364800000",
    "number": "1306850433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34-36 PROGRESS STREET",
            "address_2": "SUITE A7",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "08820",
            "telephone_number": "908-769-1440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 PROGRESS ST # 36",
            "address_2": "SUITE A7",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088201103",
            "telephone_number": "908-769-1440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "STANLEY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2008-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "MA64078",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7879601",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edison, NJ

Sources for this page

Verify at the official NPI Registry.