Active NPI
Chulsoon Kim, M.D.
- General Practice Physician
- Jackson Heights, NY
National Provider Identifier
1508904210
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 117576-1
- Practice address
- 3725 75TH St
Jackson Heights, NY 11372-6422 - Phone
- (718) 507-6262
- NPI assigned
- Feb 2, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 117576-1 | NC | Primary |
| Surgery Physician | 208600000X | 117576-1 | NY |
Addresses
Primary practice location
3725 75TH St
Jackson Heights, NY 11372-6422
Mailing address
3725 75TH St
Jackson Heights, NY 11372-6422
Phone (718) 507-6262
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0073578 | Other | NM | GHI |
| 117576-A17 | Other | NY | HEALTHFIRST |
| 673881 CK | Other | NY | BLUE CROSS & BLUE SHIELD |
| 00218268 | Medicaid | NY | |
| P3602724 | Other | NY | OXFORD |
| 169119 | Other | NY | ELDERPLAN |
| 17-00464 | Other | NY | UNITED HEALTHCARE |
| P00104843 | Other | RAILROAD MEDICARE |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 117576 | NY | MD | Clinical Social Worker |
| 117576-1 | NY | MD | Surgery Physician |
| 117576-1 | NC | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1508904210",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3725 75TH ST",
"city": "JACKSON HEIGHTS",
"state": "NY",
"postal_code": "113726422",
"telephone_number": "718-507-6262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3725 75TH ST",
"city": "JACKSON HEIGHTS",
"state": "NY",
"postal_code": "113726422",
"telephone_number": "718-507-6262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "CHULSOON",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-02",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "NC",
"license": "117576-1",
"primary": true
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NY",
"license": "117576-1",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "0073578",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHFIRST",
"identifier": "117576-A17",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS & BLUE SHIELD",
"identifier": "673881 CK",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00218268",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P3602724",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ELDERPLAN",
"identifier": "169119",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "17-00464",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00104843",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson Heights, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.