Active NPI
Soobin Im
- Clinical Child & Adolescent Psychologist
- Portland, OR
National Provider Identifier
1245844356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 3792
- Practice address
- 6443 SW Beaverton Hillsdale Hwy Ste 300
Portland, OR 97221-4210 - Phone
- (503) 452-8002
- NPI assigned
- Sep 4, 2020
- 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 |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 3792 | OR | Primary |
Addresses
Primary practice location
6443 SW Beaverton Hillsdale Hwy Ste 300
Portland, OR 97221-4210
Mailing address
6443 SW Beaverton Hillsdale Hwy Ste 300
Portland, OR 97221-4210
Phone (503) 452-8002
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726963200000",
"number": "1245844356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6443 SW BEAVERTON HILLSDALE HWY STE 300",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972214210",
"telephone_number": "503-452-8002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6443 SW BEAVERTON HILLSDALE HWY STE 300",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972214210",
"telephone_number": "503-452-8002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IM",
"first_name": "SOOBIN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-09-04",
"last_updated": "2024-09-22",
"certification_date": "2024-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "OR",
"license": "3792",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 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.