Sangmoon Kim, PH.D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

020399 Issued in NY

Practice address

32 Village Dr
Endwell, NY 13760-1062

Phone

(607) 757-3100

NPI assigned

Oct 21, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

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.

• Good Shepherd Village at Endwell, Inc.

  • Skilled Nursing Facility
  • Endwell, NY
  • NPI 1942532114
  NPD (past)

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

{
    "created_epoch": "1540080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540080000000",
    "number": "1831665579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3105 SARASOTA AVE",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138503016",
            "telephone_number": "607-239-7735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 VILLAGE DR",
            "city": "ENDWELL",
            "state": "NY",
            "postal_code": "137601062",
            "telephone_number": "607-757-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SANGMOON",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-10-21",
        "last_updated": "2018-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "020399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Constance E. Kattell
• Michelle Maria Kavanaugh, OPHTHALMIC DISPENSER
• Dawn Dolores Kerila, RN
• Istafro Michael Khalil
• Karoline Marielle Kies
• Patricia A. Kissick, LCSW-R
• Ronald L. Kissick, LCSW
• Caitlyn Knapp, FNP-C, BSN, RN
• Deborah Ann Kollar, OTR/L
• Paul James Komatinsky, LCSW

• All providers in Endwell, NY
• Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.