Active NPI
Nancy S Kim, DDS
- Periodontics
- New York, NY
National Provider Identifier
1790901593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 051284-1
- Practice address
- 115 E 61St St
14TH Floor
New York, NY 10065-8183 - Phone
- (212) 838-7219
- NPI assigned
- Apr 18, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 051284-1 | NY | Primary |
Addresses
Primary practice location
115 E 61St St
14TH Floor
New York, NY 10065-8183
Mailing address
37 W 21St St
#608
New York, NY 10010-8500
Phone (212) 838-7219
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110720000016 | NJ | Order and Referring Only - Oral Surgery | 3476721333 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051284-1 | NY | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1293408000000",
"number": "1790901593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "37 W 21ST ST",
"address_2": "#608",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100108500",
"telephone_number": "212-838-7219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 E 61ST ST",
"address_2": "14TH FLOOR",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100658183",
"telephone_number": "212-838-7219"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "NANCY",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-18",
"last_updated": "2010-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "NY",
"license": "051284-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.