Individual provider Active NPI

Yu Jin Kim

  • Physician Assistant
  • Flushing, NY
National Provider Identifier
1881013159
Registry record updated Mar 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
017273 Issued in NY
Practice address
14472 Northern Blvd Ste 203
Flushing, NY 11354-4231
Phone
(718) 886-9000
Fax
(718) 961-0666
NPI assigned
Apr 15, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 017273 NY
Physician Assistant 363A00000X 017273 NY Primary

Addresses

Primary practice location

14472 Northern Blvd Ste 203
Flushing, NY 11354-4231

Mailing address

4012 80TH St
Elmhurst, NY 11373-1234
Phone (718) 886-9000

Other practice location 1

4012 80th St
Elmhurst, NY 11373-1234
Phone (718) 886-9000

Other practice location 2

500 Grand Ave Ste 201
Englewood, NJ 07631-4968
Phone (201) 886-9000

Other practice location 3

2175 Lemoine Ave Fl 6
Fort Lee, NJ 07024-6008
Phone (201) 886-9000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20141128000000 NY Practitioner - Physician Assistant 4284956392 Reassigns benefits to 1 organization
I20160509000645 NJ Practitioner - Physician Assistant 4284956392 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Metro Dermatology of Ny,P.C.Group PAC ID 3779761705, 18 clinicians

Practice addresses (Care Compare)

25707 Union Tpke
Glen Oaks, NY 11004-1250
Phone (718) 886-9000

41 -61 Kissena Blvd
5A
Flushing, NY 11355-3105

4161 Kissena Blvd
Suite 5a
Flushing, NY 11355-3105
Phone (718) 886-9000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359

Organizations & group practices 2

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": "1397520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646092800000",
    "number": "1881013159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4012 80TH ST",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113731234",
            "telephone_number": "718-886-9000",
            "fax_number": "718-961-0666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14472 NORTHERN BLVD STE 203",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113544231",
            "telephone_number": "718-886-9000",
            "fax_number": "718-961-0666"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4012 80th St",
            "address_purpose": "LOCATION",
            "city": "Elmhurst",
            "state": "NY",
            "postal_code": "113731234",
            "country_code": "US",
            "telephone_number": "718-886-9000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "500 Grand Ave Ste 201",
            "address_purpose": "LOCATION",
            "city": "Englewood",
            "state": "NJ",
            "postal_code": "076314968",
            "country_code": "US",
            "telephone_number": "201-886-9000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2175 Lemoine Ave Fl 6",
            "address_purpose": "LOCATION",
            "city": "Fort Lee",
            "state": "NJ",
            "postal_code": "070246008",
            "country_code": "US",
            "telephone_number": "201-886-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "YU JIN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-15",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "017273",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "017273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

Verify at the official NPI Registry.