Active NPI
Minkyung So
- Marriage & Family Therapist
- Los Angeles, CA
National Provider Identifier
1003223033
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 103011
- Practice address
- 1849 Sawtelle Blvd Ste 610
Los Angeles, CA 90025-7013 - Phone
- (310) 853-8211
- NPI assigned
- Jul 22, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 80802 | CA | |
| Marriage & Family Therapist | 106H00000X | 103011 | CA | Primary |
Addresses
Primary practice location
1849 Sawtelle Blvd Ste 610
Los Angeles, CA 90025-7013
Mailing address
560 W Main St Ste C229
Alhambra, CA 91801-3374
Phone (310) 853-8211
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 80802 | CA | MD | Clinical Social Worker |
| 103011 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405987200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678838400000",
"number": "1003223033",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "560 W MAIN ST STE C229",
"city": "ALHAMBRA",
"state": "CA",
"postal_code": "918013374",
"telephone_number": "310-853-8211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1849 SAWTELLE BLVD STE 610",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900257013",
"telephone_number": "310-853-8211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SO",
"first_name": "MINKYUNG",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-07-22",
"last_updated": "2023-03-15",
"certification_date": "2023-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "80802",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "103011",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.