Individual provider Active NPI

Jessica Myung Jin Yun, LCSW

  • Clinical Social Worker
  • Los Angeles, CA
National Provider Identifier
1306323506
Registry record updated Dec 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW111693 Issued in CA
Practice address
520 S Lafayette Park PL
Unit 300
Los Angeles, CA 90057
Phone
(213) 252-2100
NPI assigned
Jul 20, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Clinical Social Worker 1041C0700X LCSW111693 CA Primary
Mental Health Counselor 101YM0800X 89210 CA

Addresses

Primary practice location

520 S Lafayette Park PL
Unit 300
Los Angeles, CA 90057

Mailing address

715 S Oxford Ave Apt 310
Los Angeles, CA 90005-2990
Phone (213) 905-9231

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230309002247 CA Practitioner - Clinical Social Worker 5698148799 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Special Service for Groups IncGroup PAC ID 2769396886, 61 clinicians

Practice addresses (Care Compare)

520 S Lafayette Park PL
FL 3
Los Angeles, CA 90057-5400
Phone (213) 252-2100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW111693CAMDClinical Social Worker
89210CAMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Special Service for Groups, Inc. CurrentSince Nov 19, 2022 Accepting new patients
Special Service for Groups, Inc. Current Accepting new patients
Special Service for Groups, Inc. CurrentSince Nov 19, 2022 Accepting new patients

Locations

905 E 8th St
Los Angeles, CA 90021
Phone (213) 553-1800

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1532044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671408000000",
    "number": "1306323506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 S OXFORD AVE APT 310",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900052990",
            "telephone_number": "213-905-9231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 S LAFAYETTE PARK PL",
            "address_2": "UNIT 300",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90057",
            "telephone_number": "213-252-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YUN",
        "first_name": "JESSICA",
        "middle_name": "MYUNG JIN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-20",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW111693",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "89210",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.