Soonie Ann Kim, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

1175 Issued in OR

Practice address

5200 SW Macadam Ave
#580
Portland, OR 97239-6103

Phone

(503) 231-7854

Fax

(503) 231-8153

NPI assigned

Apr 10, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Portland Dialectical Behavior Therapy PC

  • Cognitive & Behavioral Psychologist
  • Portland, OR
  • NPI 1619913787
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222819200000",
    "number": "1063475259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 SW MACADAM AVE",
            "address_2": "#580",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972396103",
            "telephone_number": "503-231-7854",
            "fax_number": "503-231-8153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 SW MACADAM AVE",
            "address_2": "#580",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972396103",
            "telephone_number": "503-231-7854",
            "fax_number": "503-231-8153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SOONIE",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-10",
        "last_updated": "2008-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OR",
            "license": "1175",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158831",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sharon Bokyong Kim, M.D.
• Sherry Michelle Kim, MD
• Sik Kiyoshi Kim, MD
• Sohyon Kim
• Song Jin Sunny Kim, MD
• Stephanie Kim
• Tae Yeon Kim, MD
• Tiffany Kim, O.D.
• Yongsung Kim, MD
• Yoon-Jin Kim

• Psychologist in Portland, OR
• Providers in Portland, OR by specialty
• Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.