Active NPI
Paul Im, DDS
- Dentist
- Little Neck, NY
National Provider Identifier
1669527685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 047682-1
- Practice address
- 25220 Northern Blvd Ste 200
Little Neck, NY 11362-1344 - Phone
- (718) 224-9453
- Fax
- (718) 224-9455
- NPI assigned
- Jan 23, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 047682-1 | NY | Primary |
Addresses
Primary practice location
25220 Northern Blvd Ste 200
Little Neck, NY 11362-1344
Mailing address
252-20 Northern Blvd
Suite 200
Little Neck, NY 11362
Phone (718) 224-9453
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 047682-1 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327363200000",
"number": "1669527685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "252-20 NORTHERN BLVD",
"address_2": "SUITE 200",
"city": "LITTLE NECK",
"state": "NY",
"postal_code": "11362",
"telephone_number": "718-224-9453",
"fax_number": "718-224-9455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25220 NORTHERN BLVD STE 200",
"city": "LITTLE NECK",
"state": "NY",
"postal_code": "113621344",
"telephone_number": "718-224-9453",
"fax_number": "718-224-9455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IM",
"first_name": "PAUL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-23",
"last_updated": "2012-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "047682-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Little Neck, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.