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Michael Jae Woo Kim

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

PECOS Enrollment

This provider is enrolled in PECOS as MICHAEL KIM.

Based on the most recent information from CMS, provider Michael Jae Woo Kim is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1578955019
Provider Type
Individual
Full Name
Kim, Michael Jae Woo
Title
Mr.
Credential
NP

Gender
Male
Sole Proprietor
No
Enumeration Date
2/20/2015
Last Updated
1/4/2017

Contact Information

Practice Location

85 W Burnside Ave, Bronx, NY 10453-4015

(718) 716-4400

(718) 228-7471

Mailing Location

85 W Burnside Ave, Bronx, NY 10453-4015

(718) 716-4400

(718) 228-7471

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License F341255-1 New York
Code 363LF0000X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License NP95002352 California
Code 363LF0000X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 60528082 Washington

Michael Jae Woo Kim

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

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Thyme, Ebony Princess