NPIMap

Individual provider Active NPI

Sang H Kim, M.D.

  • Dermatology Physician
  • Norwalk, CT
National Provider Identifier
1942318209
Registry record updated Feb 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
044674 Issued in CT
Practice address
761 Main Ave
Suite 102
Norwalk, CT 06851
Phone
(203) 810-4151
Fax
(203) 810-4150
NPI assigned
Aug 28, 2006
Last updated
Feb 1, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 044674 CT Primary
Dermatology Physician 207N00000X 2013-01906 NC

Addresses

Primary practice location

761 Main Ave
Suite 102
Norwalk, CT 06851

Mailing address

99 East River Drive
5TH Floor
East Hartford, CT 06108-7301
Phone (860) 282-0833

Other identifiers 2

IdentifierTypeStateIssuer
1942318209MedicaidNC
NC2066MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061116000320 CT Practitioner - Dermatology 0749253227 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
New York University School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Omar a Ibrahimi MD PHD LLCGroup PAC ID 0840448122, 3 clinicians

Practice addresses (Care Compare)

60 Commerce Park
Suite C
Milford, CT 06460-3513
Phone (203) 428-4440

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions850
Skin biopsy247

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2013-01906NCMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Omar a Ibrahimi MD PHD LLC CurrentSince Feb 2, 2023 Accepting new patients
The Connecticut Dermatology Group PLLC Dermatology CurrentSince Dec 27, 2016 Accepting new patients
Schweiger Dermatology PLLC Dermatology CurrentSince Apr 1, 2022 Accepting new patients
21St Century Dermatology,LLC PastSince Jan 1, 2002 Accepting new patients
Clark Dermatology LLC Dermatology Past Accepting new patients

Locations

600 W Putnam Ave
Greenwich, CT 06830
Phone (203) 413-0630

60 Commerce Park
Ste C
Milford, CT 06460
Phone (203) 428-4440

761 Main Ave
Ste 102
Norwalk, CT 06851
Phone (203) 810-4151

1250 Summer St
Ste 201
Stamford, CT 06905
Phone (203) 975-1112

2777 Summer St
Ste 600
Stamford, CT 06905
Phone (203) 428-4440

2701 Queens Plz N
Fl 10
Long Island City, NY 11101
Phone (203) 996-6379

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485907200000",
    "number": "1942318209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 EAST RIVER DRIVE",
            "address_2": "5TH FLOOR",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061087301",
            "telephone_number": "860-282-0833",
            "fax_number": "203-282-0170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "761 MAIN AVE",
            "address_2": "SUITE 102",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "06851",
            "telephone_number": "203-810-4151",
            "fax_number": "203-810-4150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SANG",
        "middle_name": "H",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-28",
        "last_updated": "2017-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CT",
            "license": "044674",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NC",
            "license": "2013-01906",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942318209",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NC2066",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwalk, CT

Sources for this page

Verify at the official NPI Registry.