Active NPI
Yena Kim
- Speech-Language Pathologist
- La Mirada, CA
National Provider Identifier
1124582887
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA22038
- Practice address
- 15242 Matisse Cir
La Mirada, CA 90638-4731 - Phone
- (714) 403-7988
- NPI assigned
- Jan 28, 2019
- Reactivated
- Jan 30, 2024
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SA22038 | FL | Primary |
Addresses
Primary practice location
15242 Matisse Cir
La Mirada, CA 90638-4731
Mailing address
18946 N Dale Mabry Hwy
Lutz, FL 33548-4900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Care Compare profile
Medicare Care Compare- Specialty
- Qualified Speech Language Pathologist
- Education
- Other, 2022
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
425 2ND St
Suite 405
San Francisco, CA 94107-1400
489 Sanchez St
San Francisco, CA 94114-2056
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SA22038 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706572800000",
"number": "1124582887",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18946 N DALE MABRY HWY",
"city": "LUTZ",
"state": "FL",
"postal_code": "335484900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15242 MATISSE CIR",
"city": "LA MIRADA",
"state": "CA",
"postal_code": "906384731",
"telephone_number": "714-403-7988"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "YENA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-28",
"last_updated": "2024-01-30",
"certification_date": "2024-01-30",
"deactivation_date": "2023-10-16",
"reactivation_date": "2024-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA22038",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Mirada, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.