Active NPI
Myeong Jin Kim, PSY.D
- Clinical Psychologist
- New York, NY
National Provider Identifier
1396124707
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 021616
- Practice address
- 1745 Broadway FL 17
New York, NY 10019-4642 - Phone
- (212) 851-8102
- Fax
- (212) 537-0102
- NPI assigned
- May 19, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 021616 | NY | |
| Clinical Psychologist | 103TC0700X | 021616 | NY | Primary |
Addresses
Primary practice location
1745 Broadway FL 17
New York, NY 10019-4642
Mailing address
475 48TH Ave Apt 219
Long Island City, NY 11109-5503
Phone (917) 504-1606
Other practice location 1
22215 Northern Blvd
C1
Bayside, NY 11361-3678
Phone (917) 504-1606
Other practice location 2
475 48th Ave Apt 219
Long Island City, NY 11109-5503
Phone (917) 504-1606
Other practice location 3
25220 Northern Blvd Ste 202
Little Neck, NY 11362-1344
Phone (917) 504-1606
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1431993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600128000000",
"number": "1396124707",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "475 48TH AVE APT 219",
"city": "LONG ISLAND CITY",
"state": "NY",
"postal_code": "111095503",
"telephone_number": "917-504-1606"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1745 BROADWAY FL 17",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100194642",
"telephone_number": "212-851-8102",
"fax_number": "212-537-0102"
}
],
"practiceLocations": [
{
"address_1": "22215 Northern Blvd",
"address_2": "C1",
"address_purpose": "LOCATION",
"city": "Bayside",
"state": "NY",
"postal_code": "113613678",
"country_code": "US",
"telephone_number": "917-504-1606",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "475 48th Ave Apt 219",
"address_purpose": "LOCATION",
"city": "Long Island City",
"state": "NY",
"postal_code": "111095503",
"country_code": "US",
"telephone_number": "917-504-1606",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "25220 Northern Blvd Ste 202",
"address_purpose": "LOCATION",
"city": "Little Neck",
"state": "NY",
"postal_code": "113621344",
"country_code": "US",
"telephone_number": "917-504-1606",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIM",
"first_name": "MYEONG JIN",
"name_prefix": "Dr.",
"credential": "PSY.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-05-19",
"last_updated": "2020-09-15",
"certification_date": "2020-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "021616",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "021616",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.