NPIMap

Individual provider Active NPI

Renita Kim

  • Gynecology Physician
  • Astoria, NY
National Provider Identifier
1619331618
Registry record updated May 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
304021 Issued in NY
Practice address
2520 30TH Ave FL 4
Astoria, NY 11102-2448
Phone
(718) 808-7777
NPI assigned
Apr 6, 2016
Last updated
May 18, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Gynecology Physician 207VG0400X 304021 NY Primary

Addresses

Primary practice location

2520 30TH Ave FL 4
Astoria, NY 11102-2448

Mailing address

75 Francis St
Asb1-3-608a
Boston, MA 02115-6110
Phone (617) 732-7801

Other practice location 1

75 Francis St
Asb1-3-608a
Boston, MA 02115-6110
Phone (617) 732-7801

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220720003138 NY Practitioner - Obstetrics/Gynecology 1052605276 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Icahn School of Medicine at Mount Sinai, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Gustave Levy Place
Mount Sinai Hospital
New York, NY 10029-6500
Phone (212) 241-2232

2520 30TH Ave
Astoria, NY 11102-2448
Phone (718) 808-7777

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai CurrentSince Dec 15, 2022 Accepting new patients
North Shore Medical Group of the Mount Sinai School of Medicine CurrentSince Sep 1, 2022 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Dec 15, 2022 Accepting new patients
North Shore Medical Group of the Mount Sinai School of Medicine Gynecology CurrentSince Sep 1, 2022 Accepting new patients
Mount Sinai Hospital Past Accepting new patients

Locations

13620 38th Ave
Ste 6E
Flushing, NY 11354
Phone (718) 353-7701

325 Park Ave
Huntington, NY 11743
Phone (631) 351-3700

3722 82nd St
Jackson Hts, NY 11372
Phone (718) 779-1600

2520 30th Ave
Long Island City, NY 11102
Phone (718) 267-4230

2520 30th Ave
Fl 4
Long Island City, NY 11102
Phone (718) 808-7777

5 E 98th St
Fl 2
New York, NY 10029
Phone (212) 241-6551

9901 Queens Blvd
Rego Park, NY 11374
Phone (718) 268-4500

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 5

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 6

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": "1459900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652832000000",
    "number": "1619331618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 FRANCIS ST",
            "address_2": "ASB1-3-608A",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156110",
            "telephone_number": "617-732-7801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2520 30TH AVE FL 4",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111022448",
            "telephone_number": "718-808-7777"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "75 Francis St",
            "address_2": "ASB1-3-608A",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021156110",
            "country_code": "US",
            "telephone_number": "617-732-7801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "RENITA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-06",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "NY",
            "license": "304021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Astoria, NY

Sources for this page

Verify at the official NPI Registry.