Active NPI
Young Joo Kim, PHD
- Occupational Therapist
- Edison, NJ
National Provider Identifier
1891039921
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 46TR00574000
- Practice address
- 4 Ethel Rd
Suite 403B
Edison, NJ 08817-2841 - Phone
- (732) 549-2030
- NPI assigned
- Nov 15, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OC-011208 | PA | |
| Occupational Therapist | 225X00000X | 46TR00574000 | NJ | Primary |
Addresses
Primary practice location
4 Ethel Rd
Suite 403B
Edison, NJ 08817-2841
Mailing address
4 Ethel Rd
Suite 403B
Edison, NJ 08817-2841
Phone (732) 549-2030
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 Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46TR00574000 | NJ | MD | Occupational Therapist |
| OC-011208 | PA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1352937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739232000000",
"number": "1891039921",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 ETHEL RD",
"address_2": "SUITE 403B",
"city": "EDISON",
"state": "NJ",
"postal_code": "088172841",
"telephone_number": "732-549-2030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4 ETHEL RD",
"address_2": "SUITE 403B",
"city": "EDISON",
"state": "NJ",
"postal_code": "088172841",
"telephone_number": "732-549-2030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "YOUNG JOO",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-11-15",
"last_updated": "2025-02-11",
"certification_date": "2025-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "PA",
"license": "OC-011208",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NJ",
"license": "46TR00574000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edison, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.