Active NPI
Jane Kim
- Pharmacist
- Woodside, NY
National Provider Identifier
1639562408
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 059808
- Practice address
- 6508 Roosevelt Ave
Woodside, NY 11377-2928 - Phone
- (347) 448-6965
- NPI assigned
- Mar 18, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 059808 | NY | Primary |
Addresses
Primary practice location
6508 Roosevelt Ave
Woodside, NY 11377-2928
Mailing address
6508 Roosevelt Ave
Woodside, NY 11377-2928
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
| License | State | Type | Specialty |
|---|---|---|---|
| 059808 | NY | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1426636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445817600000",
"number": "1639562408",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6508 ROOSEVELT AVE",
"city": "WOODSIDE",
"state": "NY",
"postal_code": "113772928"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6508 ROOSEVELT AVE",
"city": "WOODSIDE",
"state": "NY",
"postal_code": "113772928",
"telephone_number": "347-448-6965"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JANE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-03-18",
"last_updated": "2015-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "059808",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodside, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.