Physician Compare National (NPI:1881622504)

HEALTHCARE PROVIDER:

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

Individual Professional Information
NPI	1881622504
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7012912017
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20060926000330
	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	DONGSOO
	Individual professional first name
Provider Middle Name	SOO
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1978
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	NEPHROLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	NEPHROLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	102 VALENTINE ST
	Group Practice or individual's line 1 address
City	MOUNT VERNON
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	105502504
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9146652267
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y