Sung Jo Kim, MD

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

121585 Issued in NY

Practice address

260 Patchogue Yaphank Rd
Ste F
East Patchogue, NY 11772-4886

Phone

(631) 654-8755

Fax

(631) 654-8709

NPI assigned

Dec 7, 2005

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• North Shore-Lij Medical PC

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572
  NPD (past)

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209340800000",
    "number": "1477538908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 PATCHOGUE YAPHANK RD",
            "address_2": "STE F",
            "city": "EAST PATCHOGUE",
            "state": "NY",
            "postal_code": "117724886",
            "telephone_number": "631-654-8755",
            "fax_number": "631-654-8709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 PATCHOGUE YAPHANK RD",
            "address_2": "STE F",
            "city": "EAST PATCHOGUE",
            "state": "NY",
            "postal_code": "117724886",
            "telephone_number": "631-654-8755",
            "fax_number": "631-654-8709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SUNG JO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2008-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "121585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "W38231",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00228217",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Lyn Kelley
• Shahriar Joseph Khalili, MD
• Junaid Khan, DO
• Waqas Khan, MD
• Jung-Yong Kim, MD
• Brian G. Kincaid Jr., M.D.
• Barry C Kleeman, MD
• Michael W Kleeman, D.O.
• Leslie Esther Klyachman, MD
• Eric Knakal, M.D.

• Nephrology Physician in East Patchogue, NY
• Providers in East Patchogue, NY by specialty
• Nephrology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2008; 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.