Active NPI
Jae Yoon Im
- Occupational Therapist
- Burbank, CA
National Provider Identifier
1215713748
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT23705
- Practice address
- 4100 W Alameda Ave # 346
Burbank, CA 91505-4195 - Phone
- (818) 900-6565
- NPI assigned
- Aug 31, 2023
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT23705 | CA | Primary |
Addresses
Primary practice location
4100 W Alameda Ave # 346
Burbank, CA 91505-4195
Mailing address
940 Elden Ave Unit 302
Los Angeles, CA 90006-5845
Phone (310) 386-7768
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT23705 | CA | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Performing Arts Physical Therapy of Los Angeles Inc | Current | Accepting new patients | |
| Novum Therapy Partners, Inc. | Occupational Therapist | Past | Accepting new patients |
Locations
1106 N La Cienega Blvd
Ste 203
West Hollywood, CA 90069
Phone (310) 659-1077
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- West Hollywood, CA
- NPI 1326085838
-
- Speech-Language Pathologist
- San Antonio, TX
- NPI 1194588111
Occupational Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1770249600000",
"number": "1215713748",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "940 ELDEN AVE UNIT 302",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900065845",
"telephone_number": "310-386-7768"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4100 W ALAMEDA AVE # 346",
"city": "BURBANK",
"state": "CA",
"postal_code": "915054195",
"telephone_number": "818-900-6565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IM",
"first_name": "JAE YOON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-31",
"last_updated": "2026-02-05",
"certification_date": "2026-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "OT23705",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burbank, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.