Tae Jin Kim

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

030060 Issued in NY

Practice address

19904 47TH Ave Apt 1
Flushing, NY 11358-3955

Phone

(929) 373-5772

Fax

(914) 462-4372

NPI assigned

Jul 14, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

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

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

• Good Day Physical Therapy P.C.

  • Physical Therapist
  • Flushing, NY
  • NPI 1891569976
  Medicare reassignment NPD Authorized official
• Taejin Physical Therapy P.C.

  • Physical Therapist
  • Flushing, NY
  • NPI 1104200633
  Medicare reassignment NPD Authorized official
• Greening Acupuncture PC

  • Acupuncturist
  • Flushing, NY
  • NPI 1487224218
  NPD Authorized official

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

{
    "created_epoch": "1436832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673481600000",
    "number": "1386028801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19904 47TH AVE APT 1",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113583955",
            "telephone_number": "929-373-5772",
            "fax_number": "914-462-4372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19904 47TH AVE APT 1",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113583955",
            "telephone_number": "929-373-5772",
            "fax_number": "914-462-4372"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "105 Newbridge Rd",
            "address_purpose": "LOCATION",
            "city": "Hicksville",
            "state": "NY",
            "postal_code": "118013901",
            "country_code": "US",
            "telephone_number": "845-827-3469",
            "fax_number": "516-740-2803",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "TAE JIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-14",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "030060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sung Kim
• Sung H Kim, DDS
• Sung Uk Kim, MD
• Sung Yup Kim, MD
• Sunmi Kim, DPT
• Tae Young Kim, MSPT
• Taegyun Kim, M.D.
• Taehoon Kim, L.AC,
• Tamara Kim
• Un Jeong Kim

• Physical Therapist in Flushing, NY
• Providers in Flushing, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.