NPIMap

Organization Active NPI

Healthy Life Physicians Group, P.C.

  • Endocrinology, Diabetes & Metabolism Physician
  • Newark, NJ
National Provider Identifier
1518613843
Registry record updated Apr 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
Legal business name
HEALTHY LIFE PHYSICIANS GROUP, P.C.
Practice address
1 Gateway Ctr Ste 2600
Newark, NJ 07102-5323
Phone
(617) 505-1520
Fax
(617) 928-8401
NPI assigned
Feb 24, 2022
Last updated
Apr 14, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2026

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

Authorized official

Name
Nam Ho Kim, MDNPI 1942506472
Title
President
Phone
(617) 505-1520

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Endocrinology, Diabetes & Metabolism Physician 207RE0101X Primary

Addresses

Primary practice location

1 Gateway Ctr Ste 2600
Newark, NJ 07102-5323

Mailing address

109 State Street
5TH FL
Boston, MA 02109-2906
Phone (617) 505-1520

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220920001732 NJ Part B Supplier - Clinic/Group Practice 2062897556 Receives reassigned benefits from 2 practitioners
Practice locations: Newark, NJ

National Provider Directory

National Provider Directory
Tax ID family
Healthy Life Physicians Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1645660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776124800000",
    "number": "1518613843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 STATE STREET",
            "address_2": "5TH FL",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021092906",
            "telephone_number": "617-505-1520",
            "fax_number": "617-928-8401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GATEWAY CTR STE 2600",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071025323",
            "telephone_number": "617-505-1520",
            "fax_number": "617-928-8401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY LIFE PHYSICIANS GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-24",
        "last_updated": "2026-04-14",
        "certification_date": "2026-04-14",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "NAM",
        "authorized_official_middle_name": "HO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-505-1520",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.