Active NPI
Michael Kennedy-Yoon, MD
- Student in an Organized Health Care Education/Training Program
- Syracuse, NY
National Provider Identifier
1477297927
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 1 Childrens Cir
Syracuse, NY 13210-1634 - Phone
- (315) 464-5540
- NPI assigned
- Apr 21, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
1 Childrens Cir
Syracuse, NY 13210-1634
Mailing address
747 E Kensington Ave
Salt Lake City, UT 84105-2224
Phone (801) 554-3311
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250819003564 | CA | Order and Referring Only - Pediatric Medicine | 3375042088 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650499200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650499200000",
"number": "1477297927",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "747 E KENSINGTON AVE",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841052224",
"telephone_number": "801-554-3311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 CHILDRENS CIR",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132101634",
"telephone_number": "315-464-5540"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY-YOON",
"first_name": "MICHAEL",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-04-21",
"last_updated": "2022-04-21",
"certification_date": "2022-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2022; 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.