Active NPI
Daneil Imkyu Kim, PSYCHOLOGIST
- Psychologist
- Los Angeles, CA
National Provider Identifier
1013096551
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY19028
- Practice address
- 550 S Vermont Ave FL 4
Los Angeles, CA 90020-1912 - Phone
- (818) 351-7737
- Fax
- (213) 639-1361
- NPI assigned
- Nov 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY19028 | CA | Primary |
Addresses
Primary practice location
550 S Vermont Ave FL 4
Los Angeles, CA 90020-1912
Mailing address
12121 Shadow Ridge Way
Northridge, CA 91326-3826
Phone (818) 360-6902
Other names 1
- Dr. Daniel Kim
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 |
|---|---|---|---|
| PSY19028 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318809600000",
"number": "1013096551",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12121 SHADOW RIDGE WAY",
"city": "NORTHRIDGE",
"state": "CA",
"postal_code": "913263826",
"telephone_number": "818-360-6902",
"fax_number": "818-997-8743"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 S VERMONT AVE FL 4",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900201912",
"telephone_number": "818-351-7737",
"fax_number": "213-639-1361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "DANEIL",
"middle_name": "IMKYU",
"name_prefix": "Dr.",
"credential": "PSYCHOLOGIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-03",
"last_updated": "2011-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY19028",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "DANIEL",
"last_name": "KIM",
"prefix": "DR.",
"code": "2",
"type": "Professional Name"
}
]
}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 Oct 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.