Individual provider Active NPI

Alexander Namhyun Kim, D.O.

  • Family Medicine Physician
  • Staten Island, NY
National Provider Identifier
1659714582
Registry record updated Jun 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
278707 Issued in NY
Practice address
1551 Richmond Rd
1A
Staten Island, NY 10304-2313
Phone
(718) 987-4891
NPI assigned
Apr 10, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2021

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DO3163 ME
Family Medicine Physician 207Q00000X 25MB10470400 NJ
Family Medicine Physician 207Q00000X S3833 TX
Family Medicine Physician 207Q00000X 278707 NY Primary
Family Medicine Physician 207Q00000X DR.0065537 CO

Addresses

Primary practice location

1551 Richmond Rd
1A
Staten Island, NY 10304-2313

Mailing address

391 1St St
4R
Brooklyn, NY 11215-2548
Phone (847) 302-3646

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160531002287 NY Practitioner - Family Practice 2365732583 Reassigns benefits to 1 organization
I20210616001331 TX Practitioner - Family Practice 2365732583

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MB10470400NJMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Jan 1, 2017 Accepting new patients
New York University CurrentSince Jan 1, 2017 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1365552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1659714582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "391 1ST ST",
            "address_2": "4R",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112152548",
            "telephone_number": "847-302-3646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 RICHMOND RD",
            "address_2": "1A",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103042313",
            "telephone_number": "718-987-4891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "ALEXANDER",
        "middle_name": "NAMHYUN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-10",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "DO3163",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MB10470400",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "S3833",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "278707",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0065537",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.