Active NPI
Sang Eun Kim, PPS
- School Counselor
- Fremont, CA
National Provider Identifier
1104796853
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Counselor
- License
- 210128275
- Practice address
- 34400 Maybird Cir
Fremont, CA 94555-2917 - Phone
- (224) 475-2424
- NPI assigned
- Nov 7, 2025
- Last updated
- Nov 7, 2025
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| School Counselor | 101YS0200X | 210128275 | CA | Primary |
Addresses
Primary practice location
34400 Maybird Cir
Fremont, CA 94555-2917
Mailing address
34400 Maybird Cir
Fremont, CA 94555-2917
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 |
|---|---|---|---|
| 210128275 | CA | MD | School Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1762473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1762473600000",
"number": "1104796853",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34400 MAYBIRD CIR",
"city": "FREMONT",
"state": "CA",
"postal_code": "945552917"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34400 MAYBIRD CIR",
"city": "FREMONT",
"state": "CA",
"postal_code": "945552917",
"telephone_number": "224-475-2424"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SANG EUN",
"credential": "PPS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-11-07",
"last_updated": "2025-11-07",
"certification_date": "2025-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YS0200X",
"taxonomy_group": "",
"desc": "Counselor, School",
"state": "CA",
"license": "210128275",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fremont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.