Active NPI
Sudjono Kosim, MD
- Diagnostic Radiology Physician
- Monroe, MI
National Provider Identifier
1780779330
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 4301040246
- Practice address
- 718 N. Macomb
Monroe, MI 48161 - Phone
- (734) 240-8400
- NPI assigned
- Oct 3, 2006
- Last updated
- Jul 8, 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 |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 4301040246 | MI | Primary |
Addresses
Primary practice location
718 N. Macomb
Monroe, MI 48161
Mailing address
718 N. Macomb
Monroe, MI 48161
Phone (734) 240-8400
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3442516 | Other | MI | MOLINA HEALTHCARE |
| 3442516 | Other | MI | HEALTH PLAN OF MI |
| 12915 | Other | MI | COMMUNITY CHOICE OF MI |
| 802982 | Other | MI | COMMUNITY CARE PLAN |
| 3442490 | Medicaid | MI | |
| 38338429803 | Other | MI | CNA HEALTH SERVICES |
Other names 1
- Hong T Jay Sim
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301040246 | MI | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780779330",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "718 N. MACOMB",
"city": "MONROE",
"state": "MI",
"postal_code": "48161",
"telephone_number": "734-240-8400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "718 N. MACOMB",
"city": "MONROE",
"state": "MI",
"postal_code": "48161",
"telephone_number": "734-240-8400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOSIM",
"first_name": "SUDJONO",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "MI",
"license": "4301040246",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MOLINA HEALTHCARE",
"identifier": "3442516",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PLAN OF MI",
"identifier": "3442516",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMUNITY CHOICE OF MI",
"identifier": "12915",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMUNITY CARE PLAN",
"identifier": "802982",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3442490",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CNA HEALTH SERVICES",
"identifier": "38338429803",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "HONG T JAY",
"last_name": "SIM",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Monroe, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.