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MISOOK KIM
NPI 1205905056
Physician Assistant in Port Jefferson, NY

Active since November 07, 2006
75 N COUNTRY RD, PORT JEFFERSON, NY 11777(631) 473-1320(631) 686-7653 Get Directions Write a Review

NPPES record last updated: October 22, 2015. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Misook Kim NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MISOOK KIM (NPI 1205905056) is an individual physician assistant in Port Jefferson, New York, licensed in New York (009693) and active in the NPI registry since November 2006.

NPPES Registry Identity

NPI1205905056
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameMISOOK KIM
Location Address75 N COUNTRY RDPort Jefferson, NY 11777-2119
Mailing Address75 N Country RdPort Jefferson, NY 11777-2119 · (631) 473-1320 · Fax (631) 686-7653
Phone(631) 473-1320
Fax(631) 686-7653
Sole ProprietorNo
Enumeration DateNovember 7, 2006
Last NPPES UpdateOctober 22, 2015
✔ NPI 1205905056 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in NY · 009693
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
75 N COUNTRY RD, Port Jefferson, NY 11777
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Other Identifiers 2

Medicare PIN8251LNY
Medicare UPINQ75456NY

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JUSTINA CATHERINE MELLONE DO
Student in an Organized Health Care Education/Training Program
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 473-1320
AAKAASH VARMA MD
Dermatology
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-2549
KRISELA VOJNIKU MD
Student in an Organized Health Care Education/Training Program
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-2549
LORETTA DIDWELL
Physician Assistant
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 473-1320
RAYMOND WONG
Internal Medicine
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-7654
KATLYN ANN CONVILLE ANTHONY NP
Nurse Practitioner (Family)
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-2565
SHEHNAZ WASIM MD
Internal Medicine
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-1443
JULIA KOROBENKO DO
Student in an Organized Health Care Education/Training Program
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-2549

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Misook Kim's NPI number?

The NPI number for Misook Kim is 1205905056. It was assigned to this individual provider in the NPPES registry on November 7, 2006.

Where is Misook Kim located?

Misook Kim practices at 75 N Country Rd, Port Jefferson, NY 11777. The listed phone number is (631) 473-1320.

What is Misook Kim's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

When was this NPI record last updated?

The NPPES record for Misook Kim was last updated on October 22, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.