Mike Kim, PSY.D.

Primary specialty

Prescribing (Medical) PsychologistTaxonomy code 103TP0016X

License

0036 Issued in NM

Practice address

2900 Louisiana Boulevard Northeast
Suite C1
Albuquerque, NM 87110

Phone

(505) 884-7873

NPI assigned

Nov 16, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• New Haven Behavioral Health Services LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Albuquerque, NM
  • NPI 1255963898
  NPD (past)

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

{
    "created_epoch": "1353024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473811200000",
    "number": "1104160910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 LOUISIANA BOULEVARD NORTHEAST",
            "address_2": "SUITE C1",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87110",
            "telephone_number": "505-884-7873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 LOUISIANA BOULEVARD NORTHEAST",
            "address_2": "SUITE C1",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87110",
            "telephone_number": "505-884-7873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MIKE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-11-16",
        "last_updated": "2016-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "NM",
            "license": "0036",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY21256",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hyunnarm Kim, D.O.
• Isaac S Kim, M.D.
• Juyung Kim
• Lisa Kim
• Mi Jung Kim
• Sang Wan Kim, PHARMD
• Seo Young Kim
• Soo Jin Kim, PHARMD
• Tess Yong Kim, LPCC
• April E Kimball, FNP-BC

• Prescribing (Medical) Psychologist in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Prescribing (Medical) Psychologist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; 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.