NPIMap

Individual provider Active NPI

Jennie Kim, MD

  • Surgical Critical Care Physician
  • Brooklyn, NY
National Provider Identifier
1518347988
Registry record updated Aug 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
339907 Issued in NY
Practice address
4802 10TH Ave
Maimonides Medical Center
Brooklyn, NY 11219-2916
Phone
(718) 283-8000
NPI assigned
Jun 1, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Critical Care Physician 2086S0102X 339907 NY Primary
Trauma Surgery Physician 2086S0127X A173096 CA
Surgical Critical Care Physician 2086S0102X A173096 CA

Addresses

Primary practice location

4802 10TH Ave
Maimonides Medical Center
Brooklyn, NY 11219-2916

Mailing address

5402 Fort Hamilton Pkwy
6TH Floor
Brooklyn, NY 11219
Phone (718) 283-8375

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jennie.kim@direct.usc.edu Direct USC CARE MEDICAL GROUP, INC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220614001339 CA Practitioner - General Surgery 1951645860 Reassigns benefits to 2 organizations
I20260115002118 NY Practitioner - Critical Care (Intensivists) 1951645860 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Desert Trauma Surgeons IncGroup PAC ID 0547366106, 36 clinicians
Maimonides Faculty Practice PlanGroup PAC ID 7012808348, 251 clinicians

Practice addresses (Care Compare)

3630 E Imperial Hwy
Lynwood, CA 90262-2609
Phone (310) 900-8900

4802 10TH Ave
Brooklyn, NY 11219-2916
Phone (718) 283-6000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A173096CAMDSurgical Critical Care Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Usc Care Medical Group, Inc CurrentSince Jul 1, 2022 Accepting new patients
Desert Trauma Surgeons, Inc. Surgical Critical Care CurrentSince Aug 1, 2023 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Jul 1, 2022 Accepting new patients
Maimonides Faculty Practice Plan CurrentSince Dec 10, 2025 Accepting new patients
Maimonides Medical Center General Surgery FPP Past Accepting new patients
Maimonides Medical Center Past Accepting new patients
Edward Ezrick, M.D., P.C. Past Accepting new patients

Locations

420 34th St
Bakersfield, CA 93301
Phone (661) 324-4647

1050 Linden Ave
Long Beach, CA 90813
Phone (562) 491-9000

2051 Marengo St
Rm C5L100
Los Angeles, CA 90033
Phone (323) 409-8604

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

3630 E Imperial Hwy
Lynwood, CA 90262
Phone (310) 900-7420

4802 10th Ave
Brooklyn, NY 11219
Phone (718) 283-8724

Interoperability endpoints

  • Direct secure messaging: jennie.kim@direct.usc.edu

Organizations & group practices 7

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1433116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786406400000",
    "number": "1518347988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5402 FORT HAMILTON PKWY",
            "address_2": "6TH FLOOR",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11219",
            "telephone_number": "718-283-8375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4802 10TH AVE",
            "address_2": "MAIMONIDES MEDICAL CENTER",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112192916",
            "telephone_number": "718-283-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JENNIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-01",
        "last_updated": "2026-08-11",
        "certification_date": "2026-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "NY",
            "license": "339907",
            "primary": true
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "CA",
            "license": "A173096",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "CA",
            "license": "A173096",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jennie.kim@direct.usc.edu",
            "affiliation": "Y",
            "affiliationName": "USC CARE MEDICAL GROUP, INC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1520 San Pablo St",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900335310",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.