Victoria Kim

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

349780 Issued in NY

Practice address

1660 Route 112 Unit C-1
Port Jefferson Station, NY 11776-8057

Phone

(631) 792-7278

NPI assigned

Aug 24, 2022

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Shore to Shore Psychiatry P.C.

  • Psychiatry Physician
  • Port Jefferson Station, NY
  • NPI 1558129932
  NPD (past)

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

{
    "created_epoch": "1661299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678665600000",
    "number": "1437878295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 ROUTE 112 UNIT C-1",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117768057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1660 ROUTE 112 UNIT C-1",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117768057",
            "telephone_number": "631-792-7278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "VICTORIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-24",
        "last_updated": "2023-03-13",
        "certification_date": "2023-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "349780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kid Smiles Pediatric Dentistry of Port Jefferson Station PLLC
• Kids First Pediatrics, PC
• Kim Lehnert, Psychology, PH.D., PLLC
• Jamey Kim
• Sang H Kim
• Kimberly a. Frasca, Psy.D. PC
• Erin Elizabeth Kincaid, MSED
• Kinexion LTC Pharmacy LLC
• Eleana Kitz, NP
• Neil Jhan Klatsky, LCSW-R, ACSW, BCD

• Family Nurse Practitioner in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; 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.