Individual provider Active NPI

Moon Kyung Kim, RPH

  • Pharmacist
  • New York, NY
National Provider Identifier
1861567026
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
028931 Issued in NY
Practice address
1870 Lexington Ave
New York, NY 10029-2046
Phone
(212) 348-2117
Fax
(212) 348-7688
NPI assigned
Nov 22, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 028931 NY Primary

Addresses

Primary practice location

1870 Lexington Ave
New York, NY 10029-2046

Mailing address

4 Meadow LN
Manhasset, NY 11030-3925
Phone (516) 869-6760

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
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
028931NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Raysol Drugs Inc Current Accepting new patients

Locations

1870 Lexington Ave
New York, NY 10029
Phone (212) 348-2117

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1861567026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 MEADOW LN",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110303925",
            "telephone_number": "516-869-6760",
            "fax_number": "516-869-6762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1870 LEXINGTON AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100292046",
            "telephone_number": "212-348-2117",
            "fax_number": "212-348-7688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MOON",
        "middle_name": "KYUNG",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "028931",
            "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 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.

Verify at the official NPI Registry.