Eleanor Kim, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY30899 Issued in CA

Practice address

5655 Lindero Canyon Rd Ste 521-21
Westlake Village, CA 91362-4016

Phone

(617) 947-5123

NPI assigned

Sep 14, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 19, 2016 through Apr 19, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• President & Fellows of Harvard College

  • Multi-Specialty Clinic/Center
  • Cambridge, MA
  • NPI 1952366312
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596844800000",
    "number": "1295830982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 426",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930110426",
            "telephone_number": "617-947-5123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5655 LINDERO CANYON RD STE 521-21",
            "city": "WESTLAKE VILLAGE",
            "state": "CA",
            "postal_code": "913624016",
            "telephone_number": "617-947-5123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "ELEANOR",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-14",
        "last_updated": "2020-08-08",
        "certification_date": "2020-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MA",
            "license": "7816",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY30899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rajesh Khanna, M.D
• Kibo Psychiatry and Wellness Corp
• Kids and Company Therapeutic Intervention Company, Inc.
• Kids Master Skills LLC
• Daniel Kwangkyum Kim, L.AC
• Eun Sang Sang Kim
• Jiyoung Kim
• Kap Ryong Kim, D.C., LA.C
• Sujin Kim, PA
• Thomas Jinkyu Kim, MD

• Psychologist in Westlake Village, CA
• Providers in Westlake Village, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2020; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.