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Individual provider Active NPI

Yeonsoo Kim, FNP

  • Family Nurse Practitioner
  • Rego Park, NY
National Provider Identifier
1518526375
Registry record updated Apr 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
089965-23 Issued in NH
Practice address
9960 64TH Ave Apt 3U
Rego Park, NY 11374-2661
Phone
(917) 340-3570
NPI assigned
Jun 6, 2019
Last updated
Apr 13, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 089965-23 NH Primary

Addresses

Primary practice location

9960 64TH Ave Apt 3U
Rego Park, NY 11374-2661

Mailing address

9201 E Mountain View Rd Ste 220
Scottsdale, AZ 85258-5172

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH, VT2 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
I20230606000228 NH Practitioner - Nurse Practitioner 9133586233 Reassigns benefits to 4 organizations
I20231106003373 VT Practitioner - Nurse Practitioner 9133586233 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Comprehensive Rehab Consultants PLLCGroup PAC ID 6800220682, 251 clinicians
Little Rivers Health Care, Inc.Group PAC ID 8224031497, 30 clinicians

Practice addresses (Care Compare)

105 Chester Rd
Springfield, VT 05156-2106
Phone (802) 886-8900

437 S Main St
Bradford, VT 05033-0338
Phone (802) 222-9317

65 Main St
Wells River, VT 05081-3000
Phone (807) 757-2325

720 Village Rd
East Corinth, VT 05040-9783
Phone (802) 439-5321

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
089965-23NHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Little Rivers Health Care, Inc. Current Accepting new patients
Little Rivers Health Care, Inc. CurrentSince Oct 27, 2025 Accepting new patients
Comprehensive Rehab Consultants PLLC Family CurrentSince May 1, 2023 Accepting new patients
Little Rivers Health Care, Inc. Family CurrentSince Oct 27, 2025 Accepting new patients

Locations

415 W Golf Rd
Ste 26
Arlington Hts, IL 60005

30 Colby Ct
Bedford, NH 03110
Phone (603) 267-0527

4628 Main St S
Newbury, VT 05051
Phone (802) 866-3000

105 Chester Rd
Springfield, VT 05156
Phone (802) 885-5741

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1559779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681344000000",
    "number": "1518526375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9201 E MOUNTAIN VIEW RD STE 220",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852585172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9960 64TH AVE APT 3U",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113742661",
            "telephone_number": "917-340-3570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "YEONSOO",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-06",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NH",
            "license": "089965-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rego Park, NY

Sources for this page

Verify at the official NPI Registry.