Infectious Disease Specialists of Connecticut, LLC

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

License

031353 Issued in CT

Legal business name

INFECTIOUS DISEASE SPECIALISTS OF CONNECTICUT, LLC

Practice address

2660 Main St
Suite 221
Bridgeport, CT 06606-5369

Phone

(203) 659-1599

Fax

(203) 659-1599

NPI assigned

May 19, 2009

Organization subpart

No

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

Authorized official

Name

Grace P. Kim, M.D.

Title

Member

Phone

(203) 659-1599

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1242691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660780800000",
    "number": "1336374339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 797",
            "city": "WILTON",
            "state": "CT",
            "postal_code": "068970797",
            "telephone_number": "203-659-1599",
            "fax_number": "203-382-0189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2660 MAIN ST",
            "address_2": "SUITE 221",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066065369",
            "telephone_number": "203-659-1599",
            "fax_number": "203-659-1599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INFECTIOUS DISEASE SPECIALISTS OF CONNECTICUT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-19",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "GRACE",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "203-659-1599",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "CT",
            "license": "031353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Infectious Disease Physician in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Infectious Disease Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.