Individual provider Active NPI

SE Hee Kim

  • Acupuncturist
  • Nyack, NY
National Provider Identifier
1619771110
Registry record updated Apr 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
License
007695 Issued in NY
Practice address
265 N Highland Ave Ste 105
Nyack, NY 10960-1444
Phone
(845) 418-0809
NPI assigned
Apr 3, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X 007695 NY Primary

Addresses

Primary practice location

265 N Highland Ave Ste 105
Nyack, NY 10960-1444

Mailing address

73 Phelps Ave
Cresskill, NJ 07626-2421
Phone (917) 885-2294

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

State licenses

LicenseStateTypeSpecialty
007695NYMDMental Health Counselor

NPI Registry JSON

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

{
    "created_epoch": "1743638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743638400000",
    "number": "1619771110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73 PHELPS AVE",
            "city": "CRESSKILL",
            "state": "NJ",
            "postal_code": "076262421",
            "telephone_number": "917-885-2294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "265 N HIGHLAND AVE STE 105",
            "city": "NYACK",
            "state": "NY",
            "postal_code": "109601444",
            "telephone_number": "845-418-0809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SE HEE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-04-03",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NY",
            "license": "007695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nyack, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 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.

Verify at the official NPI Registry.