Samuel Kim, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY.0005752 Issued in CO

Practice address

14800 Quorum Dr Ste 274
Dallas, TX 75254-1420

Phone

(214) 885-5467

NPI assigned

Feb 6, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1391644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678233600000",
    "number": "1316361728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "789 N CLARE AVE",
            "city": "HARRISON",
            "state": "MI",
            "postal_code": "486259194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14800 QUORUM DR STE 274",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752541420",
            "telephone_number": "214-885-5467"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "789 N Clare Ave",
            "address_purpose": "LOCATION",
            "city": "Harrison",
            "state": "MI",
            "postal_code": "486259194",
            "country_code": "US",
            "telephone_number": "989-539-2141",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-02-06",
        "last_updated": "2023-03-08",
        "certification_date": "2023-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301015832",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "TX",
            "license": "71316",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CO",
            "license": "PSY.0005752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter Tae Wan Kim, MD
• Rachel Kim, MD
• Rebecca Daeun Kim
• Richard Kim, MD
• Ronnie Kim, O.D.
• Samuel Sangtaek Kim, D.D.S.
• Sangkyu Steve Kim, D.D.S.
• Sara Eunah Kim
• SE-in Kim, M. A. CCC-SLP
• Sebyuk Chloe Kim, DMD

• Psychologist in Dallas, TX
• Providers in Dallas, TX by specialty
• Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.