Active NPI
Daniel Chongmyung Kim
- Marriage & Family Therapist
- San Diego, CA
National Provider Identifier
1114387339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- LMFT78887
- Practice address
- 3160 Camino del Rio S
#304
San Diego, CA 92108-3813 - Phone
- (619) 819-0283
- NPI assigned
- Mar 1, 2016
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | LMFT78887 | CA | Primary |
Addresses
Primary practice location
3160 Camino del Rio S
#304
San Diego, CA 92108-3813
Mailing address
3160 Camino del Rio S
#304
San Diego, CA 92108-3813
Phone (619) 819-0283
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 4, 2026 through Jan 4, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMFT78887 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Potentia Family Therapy, Inc. | Marriage & Family Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Marriage & Family Therapist
- San Diego, CA
- NPI 1225316391
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1456790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456790400000",
"number": "1114387339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3160 CAMINO DEL RIO S",
"address_2": "#304",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921083813",
"telephone_number": "619-819-0283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3160 CAMINO DEL RIO S",
"address_2": "#304",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921083813",
"telephone_number": "619-819-0283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "DANIEL",
"middle_name": "CHONGMYUNG",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-03-01",
"last_updated": "2016-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "LMFT78887",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.