NPIMap

Individual provider Active NPI

Tae Hyung Kim

  • Diagnostic Radiology Physician
  • New York, NY
National Provider Identifier
1326715376
Registry record updated Aug 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
P110238 Issued in NY
Practice address
475 Main St Apt 14D
New York, NY 10044-0094
Phone
(617) 460-9639
NPI assigned
Aug 26, 2021
Last updated
Aug 26, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X P110238 NY Primary

Addresses

Primary practice location

475 Main St Apt 14D
New York, NY 10044-0094

Mailing address

475 Main St Apt 14D
New York, NY 10044-0094
Phone (617) 460-9639

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230302000972 NY Practitioner - Diagnostic Radiology 8527431162 Reassigns benefits to 1 organization
I20230330003073 NJ Practitioner - Diagnostic Radiology 8527431162 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mskcc Radiology GroupGroup PAC ID 3971494683, 192 clinicians
MSK BergenGroup PAC ID 1456614114, 254 clinicians
MSK MonmouthGroup PAC ID 1153619291, 300 clinicians

Practice addresses (Care Compare)

1275 York Ave
New York, NY 10065-6007
Phone (212) 639-2000

136 Mountainview Blvd
Basking Ridge, NJ 07920-3444
Phone (908) 542-3000

225 Summit Ave
Montvale, NJ 07645-1523
Phone (908) 542-3336

480 Red Hill Rd
Middletown, NJ 07748-3052
Phone (908) 542-3007

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
P110238NYMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Sloan Kettering Cancer Center at Basking Ridge New Jersey Diagnostic Radiology CurrentSince Jan 17, 2023 Accepting new patients
MSK Bergen Diagnostic Radiology CurrentSince Jan 17, 2023 Accepting new patients
MSK Monmouth Diagnostic Radiology CurrentSince Jan 17, 2023 Accepting new patients

Locations

136 Mountainview Blvd
Basking Ridge, NJ 07920
Phone (908) 542-3000

480 Red Hill Rd
Middletown, NJ 07748
Phone (908) 542-3007

225 Summit Ave
Montvale, NJ 07645
Phone (908) 542-3336

1275 York Ave
New York, NY 10065
Phone (212) 639-3813

633 3rd Ave
Fl 4
New York, NY 10017
Phone (646) 227-3764

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 4

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 8

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": "1629936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629936000000",
    "number": "1326715376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 MAIN ST APT 14D",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100440094",
            "telephone_number": "617-460-9639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 MAIN ST APT 14D",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100440094",
            "telephone_number": "617-460-9639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "TAE HYUNG",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-26",
        "last_updated": "2021-08-26",
        "certification_date": "2021-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "P110238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.