Physician Compare National (NPI:1083022149)

HEALTHCARE PROVIDER: CHANGRAE KIM DPM

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1083022149
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9638391592
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20141107001450
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KIM
	Individual professional last name
Provider First Name	CHANGRAE
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	TEMPLE UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2008
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	16410 NORTHERN BLVD
	Group Practice or individual's line 1 address
City	FLUSHING
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	113582677
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7183211063
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	330395
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST JOHN'S EPISCOPAL HOSPITAL AT SOUTH SHORE
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y