Active NPI
Jason Kim
- Clinical Social Worker
- Culver City, CA
National Provider Identifier
1205440104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 122986
- Practice address
- 5350 Machado Rd
Culver City, CA 90230 - Phone
- (310) 204-3300
- NPI assigned
- Sep 8, 2020
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 122986 | CA | Primary |
Addresses
Primary practice location
5350 Machado Rd
Culver City, CA 90230
Mailing address
143 N Manhattan PL
Los Angeles, CA 90004-4059
Phone (818) 326-5111
Other practice location 1
127 Broadway Ste 205
Santa Monica, CA 90401-2330
Phone (213) 478-1129
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 |
|---|---|---|---|
| 122986 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720742400000",
"number": "1205440104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "143 N MANHATTAN PL",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900044059",
"telephone_number": "818-326-5111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5350 MACHADO RD",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "90230",
"telephone_number": "310-204-3300"
}
],
"practiceLocations": [
{
"address_1": "127 Broadway Ste 205",
"address_purpose": "LOCATION",
"city": "Santa Monica",
"state": "CA",
"postal_code": "904012330",
"country_code": "US",
"telephone_number": "213-478-1129",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIM",
"first_name": "JASON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-08",
"last_updated": "2024-07-12",
"certification_date": "2024-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "122986",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Culver City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.