Jiyon Jennifer Kim, P.A.-C., MPAS

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

006956 Issued in NY

Practice address

727 Broadway
Suite B4
Massapequa, NY 11758

Phone

(516) 799-0210

Fax

(516) 799-6569

NPI assigned

Nov 2, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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 1

Specialty

Physician Assistant

Education

State University of New York Downstate Medical Center, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• CM Blaine MD PLLC

  • Dermatology Physician
  • East Patchogue, NY
  • NPI 1396514618
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557792000000",
    "number": "1942388061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 PARK AVE",
            "address_2": "STE 500",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "117433979",
            "telephone_number": "631-271-2769",
            "fax_number": "631-271-1730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "727 BROADWAY",
            "address_2": "SUITE B4",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "11758",
            "telephone_number": "516-799-0210",
            "fax_number": "516-799-6569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JIYON",
        "middle_name": "JENNIFER",
        "credential": "P.A.-C., MPAS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-02",
        "last_updated": "2019-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "006956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Irina Kholodny, R-PAC
• Heidi L Kiernan, L.AC.
• Stephanie Doughty Kilgannon
• Barbara Ann Kilgus, LCSW-R
• James J Kim
• Young Chul Kim
• Kenisha Tedra King
• Patricia Kinneary, NP
• Anthony Michael Kiriakos, OTR/L
• Stefanie Kitsos

• Surgical Physician Assistant in Massapequa, NY
• Providers in Massapequa, NY by specialty
• Surgical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.