Active NPI
Jean M. Kim, PHD
- Clinical Psychologist
- Boise, ID
National Provider Identifier
1205214194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY60847665
- Practice address
- 500 W. Fort St
CRH, 2ND Floor
Boise, ID 83702-4501 - Phone
- (208) 422-1018
- NPI assigned
- May 11, 2015
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Clinical Psychologist | 103TC0700X | PY60847665 | WA | Primary |
Addresses
Primary practice location
500 W. Fort St
CRH, 2ND Floor
Boise, ID 83702-4501
Mailing address
1660 S. Columbian Way
S-116-MHC
Seattle, WA 98108-1597
Other practice location 1
3620 McClintock Ave
Los Angeles, CA 90089-0105
Phone (213) 740-1600
Other practice location 2
1660 S. Columbian Way
S-116-MHC
Seattle, WA 98108-1597
Phone (989) 430-9847
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: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1431302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727740800000",
"number": "1205214194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1660 S. COLUMBIAN WAY",
"address_2": "S-116-MHC",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981081597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 W. FORT ST",
"address_2": "CRH, 2ND FLOOR",
"city": "BOISE",
"state": "ID",
"postal_code": "837024501",
"telephone_number": "208-422-1018"
}
],
"practiceLocations": [
{
"address_1": "3620 McClintock Ave",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900890105",
"country_code": "US",
"telephone_number": "213-740-1600",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1660 S. Columbian Way",
"address_2": "S-116-MHC",
"address_purpose": "LOCATION",
"city": "Seattle",
"state": "WA",
"postal_code": "981081597",
"country_code": "US",
"telephone_number": "989-430-9847",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIM",
"first_name": "JEAN",
"middle_name": "M.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-05-11",
"last_updated": "2024-10-01",
"certification_date": "2024-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PY60847665",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.