Jungyop Kim, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

214678 Issued in NY

Practice address

101 Hospital Rd
E Patchogue, NY 11772-4870

Phone

(631) 687-4131

Fax

(631) 654-7376

NPI assigned

Aug 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1232496000000",
    "number": "1427064153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5410 MARYLAND WAY",
            "address_2": "SUITE 300",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275064",
            "telephone_number": "615-377-5667",
            "fax_number": "949-567-9827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 HOSPITAL RD",
            "city": "E PATCHOGUE",
            "state": "NY",
            "postal_code": "117724870",
            "telephone_number": "631-687-4131",
            "fax_number": "631-654-7376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JUNGYOP",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2009-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "214678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY EMPIRE BCBS",
            "identifier": "633AX1",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02772190",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01986598",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Candyce Fahner, RN IBCLC
• Alexander Seth Finger, M.D.
• Jennifer Fulton, PA
• Lauren M Galatro-Negri
• Diane B Gay, NP
• Alexandra M Lamothe, FNP
• Shatoya Ashlee Lee
• Steven P. Leon, M.D.
• Long Island Neuroscience Specialists LLP
• Louis Malerba

• All providers in E Patchogue, NY
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.