Grace Kim, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY18558 Issued in CA

Practice address

150 E Meda Ave Ste 230
Glendora, CA 91741-2624

Phone

(626) 593-6306

NPI assigned

Jan 19, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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 Harbor Counseling and Psychological Services

  • Marriage & Family Therapist
  • Glendora, CA
  • NPI 1326832643
  NPD
• New Harbor Counseling LLC

  • Marriage & Family Therapist
  • Glendora, CA
  • NPI 1427757269
  NPD

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

{
    "created_epoch": "1705622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705622400000",
    "number": "1104687979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 W. FOOTHILL BLVD SUITE C #517",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "91711",
            "telephone_number": "626-593-6306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 E MEDA AVE STE 230",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917412624",
            "telephone_number": "626-593-6306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "GRACE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-19",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY18558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Naveed Abas Khan, MD
• Nida Kichkla, NP
• Kathleen Kiely, RPH
• Christopher Kim
• David Y Kim, PA-C
• Grace Mijin Kim, DDS
• Myong-Su Jeffrey Kim
• Sang Woo Kim
• Kimberlee Mendoza Marriage and Family Therapy
• Karen Anne Kimmons

• Clinical Psychologist in Glendora, CA
• Providers in Glendora, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; 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.