Active NPI
Yountae Kim
- Pharmacist
- Rio Rancho, NM
National Provider Identifier
1417569161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 03439979
- Practice address
- 780 Nicklaus Dr SE
Rio Rancho, NM 87124-3432 - Phone
- (419) 231-0998
- NPI assigned
- Aug 22, 2020
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP00009333 | NM | |
| Pharmacist | 183500000X | 03439979 | OH | Primary |
Addresses
Primary practice location
780 Nicklaus Dr SE
Rio Rancho, NM 87124-3432
Mailing address
780 Nicklaus Dr SE
Rio Rancho, NM 87124-3432
Phone (419) 231-0998
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP00009333 | NM | MD | Pharmacist |
| 03439979 | OH | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598054400000",
"number": "1417569161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "780 NICKLAUS DR SE",
"city": "RIO RANCHO",
"state": "NM",
"postal_code": "871243432",
"telephone_number": "419-231-0998"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "780 NICKLAUS DR SE",
"city": "RIO RANCHO",
"state": "NM",
"postal_code": "871243432",
"telephone_number": "419-231-0998"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "YOUNTAE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-22",
"last_updated": "2020-08-22",
"certification_date": "2020-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NM",
"license": "RP00009333",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OH",
"license": "03439979",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rio Rancho, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.