Active NPI
Kelly Kim
- Counselor
- El Segundo, CA
National Provider Identifier
1154987790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- R1335190119
- Practice address
- 329 Eucalyptus Dr Apt C
El Segundo, CA 90245-4252 - Phone
- (310) 402-7370
- NPI assigned
- May 18, 2019
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | R1335190119 | CA | Primary |
Addresses
Primary practice location
329 Eucalyptus Dr Apt C
El Segundo, CA 90245-4252
Mailing address
329 Eucalyptus Dr Apt C
El Segundo, CA 90245-4252
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 |
|---|---|---|---|
| R1335190119 | CA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558137600000",
"number": "1154987790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "329 EUCALYPTUS DR APT C",
"city": "EL SEGUNDO",
"state": "CA",
"postal_code": "902454252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "329 EUCALYPTUS DR APT C",
"city": "EL SEGUNDO",
"state": "CA",
"postal_code": "902454252",
"telephone_number": "310-402-7370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "KELLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-18",
"last_updated": "2019-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "CA",
"license": "R1335190119",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Segundo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.