Active NPI
Young Ji Jenice Kim, M.D.
- Psychiatry Physician
- Pasadena, CA
National Provider Identifier
1154773422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A140581
- Practice address
- 92 N Madison Ave Ste 2
Pasadena, CA 91101-1740 - Phone
- (626) 784-6604
- Fax
- (626) 412-3808
- NPI assigned
- Jul 11, 2016
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | A140581 | CA | Primary |
Addresses
Primary practice location
92 N Madison Ave Ste 2
Pasadena, CA 91101-1740
Mailing address
92 N Madison Ave Ste 2
Pasadena, CA 91101-1740
Phone (626) 784-6604
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 21, 2022 through Jul 21, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A140581 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655769600000",
"number": "1154773422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "92 N MADISON AVE STE 2",
"city": "PASADENA",
"state": "CA",
"postal_code": "911011740",
"telephone_number": "626-784-6604",
"fax_number": "626-412-3808"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "92 N MADISON AVE STE 2",
"city": "PASADENA",
"state": "CA",
"postal_code": "911011740",
"telephone_number": "626-784-6604",
"fax_number": "626-412-3808"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "YOUNG JI JENICE",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-11",
"last_updated": "2022-06-21",
"certification_date": "2022-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A140581",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.