Individual provider Active NPI

Dong Uk Kim, DPM

  • Podiatrist
  • New York, NY
National Provider Identifier
1720475890
Registry record updated Jan 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
006900 Issued in NY
Practice address
291 3Rd Ave
New York, NY 10010-5502
Phone
(212) 995-1500
Fax
(212) 995-1631
NPI assigned
Apr 16, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 006900 NY Primary

Addresses

Primary practice location

291 3Rd Ave
New York, NY 10010-5502

Mailing address

14477 Roosevelt Ave Apt 4D
Flushing, NY 11354-6271

Other practice location 1

5901 69th St
Maspeth, NY 11378-2946
Phone (718) 639-3338

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190716002280 NY Practitioner - Podiatry 7214271568 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
New York College of Podiatric Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optum Medical Care PCGroup PAC ID 9931013240, 1,013 clinicians

Practice addresses (Care Compare)

5901 69TH St
Maspeth, NY 11378-2946
Phone (718) 639-3338

90 S Bedford Rd
Mount Kisco, NY 10549-3412
Phone (914) 241-1050

Hospital & facility affiliations

  • Long Island Jewish Medical Center Hospital, New Hyde Park, NY, CCN 330195

Merit-based Incentive Payment System (MIPS)

Final score
82.13 of 100Reported as group
Quality
72.13
Promoting interoperability
91
Improvement activities
40
Cost
75.81

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue26
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2022 Accepting new patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2022 Accepting new patients
Optum Urgent Care, PLLC CurrentSince Dec 1, 2019 Accepting new patients
Mount Kisco Medical Group Past Accepting new patients

Locations

555 N Broadway
Jericho, NY 11753
Phone (516) 597-5070

5901 69th St
Maspeth, NY 11378
Phone (718) 639-3338

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

110 S Bedford Rd
Mount Kisco, NY 10549
Phone (763) 910-9192

2800 Marcus Ave
Ste 202
New Hyde Park, NY 11042
Phone (516) 216-1777

2800 Marcus Ave
New Hyde Park, NY 11042
Phone (516) 622-6131

2800 Marcus Ave
Ste 207
New Hyde Park, NY 11042
Phone (516) 622-3377

291 3rd Ave
New York, NY 10010
Phone (212) 685-4849

Philadelphia, PA 19195

Interoperability endpoints

  • Direct secure messaging: dkim19582@direct.optum.com

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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": "1429142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577923200000",
    "number": "1720475890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14477 ROOSEVELT AVE APT 4D",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113546271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "291 3RD AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100105502",
            "telephone_number": "212-995-1500",
            "fax_number": "212-995-1631"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5901 69th St",
            "address_purpose": "LOCATION",
            "city": "Maspeth",
            "state": "NY",
            "postal_code": "113782946",
            "country_code": "US",
            "telephone_number": "718-639-3338",
            "fax_number": "718-639-5184",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "DONG",
        "middle_name": "UK",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-16",
        "last_updated": "2020-01-02",
        "certification_date": "2020-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NY",
            "license": "006900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.