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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

JENNA BORA KIM
NPI 1730990417
Physician Assistant in Patchogue, NY

Active since January 14, 2025PECOS Enrolled
101 HOSPITAL RD, PATCHOGUE, NY 11772(631) 654-7100 Get Directions Write a Review

NPPES record last updated: October 27, 2026. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Oct 27, 2026, Mar 12, 2025 (2 updates tracked since 2025).

About Jenna Bora Kim NPPES

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

JENNA BORA KIM (NPI 1730990417) is an individual physician assistant in Patchogue, New York and active in the NPI registry since January 2025. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1730990417
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameJENNA BORA KIM
Location Address101 HOSPITAL RDPatchogue, NY 11772-4870
Mailing Address11951 Modena LnOrlando, FL 32827-7161
Phone(631) 654-7100
Sole ProprietorYes
Enumeration DateJanuary 14, 2025
Last NPPES UpdateOctober 27, 20262 updates tracked since enumeration
NPPES CertifiedOctober 27, 2026
✔ NPI 1730990417 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
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.
101 HOSPITAL RD, Patchogue, NY 11772
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jenna Bora Kim is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11772 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$105.06 typical visit price
range $67.40 – $203.53
Typical copayment $26.26 (range $16.85 – $50.88)
Most-billed visit code 99203
Established Patient
$83.44 typical visit price
range $21.66 – $164.45
Typical copayment $20.86 (range $5.41 – $41.11)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

VAISHALI MEHTA MD
Internal Medicine (Critical Care Medicine)
101 HOSPITAL RD
PATCHOGUE, NY 11772
Suffolk County (631) 654-7100
COURTNEY BOFINGER PA
Physician Assistant
101 HOSPITAL RD
PATCHOGUE, NY 11772
Suffolk County (631) 654-7100
TAHA A SIDDIQUI MD
Internal Medicine
101 HOSPITAL RD
PATCHOGUE, NY 11772
Suffolk County (631) 473-1320
NYU LANGONE HOSPITALS
Clinic/Center (Mental Health (Including Community Mental Health Center))
101 HOSPITAL RD
PATCHOGUE, NY 11772
Suffolk County (631) 654-7175
ANNETTE POPE-MORRIS PA
Physician Assistant (Medical)
101 HOSPITAL RD
PATCHOGUE, NY 11772
Suffolk County (631) 654-7100
CARLOS KIM
Student in an Organized Health Care Education/Training Program
101 HOSPITAL RD
PATCHOGUE, NY 11772
Suffolk County (631) 654-7170
MEAGHAN CHOU PA-C
Physician Assistant
101 HOSPITAL RD
PATCHOGUE, NY 11772
Suffolk County (631) 654-7100
AUSTIN DANIEL BUDHRAM PA-C
Physician Assistant (Medical)
101 HOSPITAL RD
PATCHOGUE, NY 11772
Suffolk County (631) 654-7100

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 Jenna Kim's NPI number?

The NPI number for Jenna Kim is 1730990417. It was assigned to this individual provider in the NPPES registry on January 14, 2025.

Where is Jenna Kim located?

Jenna Kim practices at 101 Hospital Rd, Patchogue, NY 11772. The listed phone number is (631) 654-7100.

What is Jenna Kim's specialty?

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

Is Jenna Kim enrolled in Medicare?

Yes. Jenna Kim is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jenna Kim was last updated on October 27, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 days 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.