Active NPI
Jaebeom Kim
- Physical Therapist
- New York, NY
National Provider Identifier
1891366894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 047325-01
- Practice address
- 33 W 46TH St Ste 801W
New York, NY 10036-4103 - Phone
- (909) 272-8871
- NPI assigned
- Jul 9, 2021
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 047325-01 | NY | Primary |
Addresses
Primary practice location
33 W 46TH St Ste 801W
New York, NY 10036-4103
Mailing address
4028 College Point Blvd Apt 1105
Flushing, NY 11354-5150
Phone (909) 272-8871
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210720002048 | NY | Practitioner - Physical Therapist in Private Practice | 1153724752 | Practice locations: Forest Hills, NY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 047325 | NY | MD | Pharmacist |
| 047325-01 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712016000000",
"number": "1891366894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4028 COLLEGE POINT BLVD APT 1105",
"city": "FLUSHING",
"state": "NY",
"postal_code": "113545150",
"telephone_number": "909-272-8871"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33 W 46TH ST STE 801W",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100364103",
"telephone_number": "909-272-8871"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JAEBEOM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-09",
"last_updated": "2024-04-02",
"certification_date": "2024-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "047325-01",
"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 Apr 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.