Active NPI
Michael Joon Kim, M.D.
- Surgery Physician
- Rochester, NY
National Provider Identifier
1487667374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 254292
- Practice address
- 1415 Portland Ave
Rochester, NY 14621-3038 - Phone
- (585) 922-4840
- Fax
- (585) 922-3950
- NPI assigned
- Aug 14, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 254292 | NY | Primary |
Addresses
Primary practice location
1415 Portland Ave
Rochester, NY 14621-3038
Mailing address
1415 Portland Ave
Rochester, NY 14621-3038
Phone (585) 922-4840
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03256008/RGH | Medicaid | NY | |
| 03635045 | Medicaid | NY |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 254292 | NY | MD | Surgery Physician |
Interoperability endpoints
- mkim98778@direct.rochesterregional.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389830400000",
"number": "1487667374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1415 PORTLAND AVE",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146213038",
"telephone_number": "585-922-4840",
"fax_number": "585-922-3950"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1415 PORTLAND AVE",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146213038",
"telephone_number": "585-922-4840",
"fax_number": "585-922-3950"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MICHAEL",
"middle_name": "JOON",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-14",
"last_updated": "2014-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NY",
"license": "254292",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "03256008/RGH",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "03635045",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rochester, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.