Jisun Kim, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

22683 Issued in CA

Practice address

875 N Brea Blvd
Brea, CA 92821-2606

Phone

(714) 529-6842

NPI assigned

Jul 23, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Irene Kim Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1595462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647043200000",
    "number": "1346859592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6172 INDIANA AVE",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906212566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 N BREA BLVD",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928212606",
            "telephone_number": "714-529-6842"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6172 Indiana Ave",
            "address_purpose": "LOCATION",
            "city": "Buena Park",
            "state": "CA",
            "postal_code": "906212566",
            "country_code": "US",
            "telephone_number": "714-469-6624",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "JISUN",
        "name_prefix": "Miss",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-23",
        "last_updated": "2022-03-12",
        "certification_date": "2022-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "22683",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IRENE",
            "last_name": "KIM",
            "prefix": "MISS",
            "credential": "OTR/L",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Eun Kim
• Eunice Hope Kim, LCSW
• Helen G Kim
• Janna Kim, PHARM D
• Jessica Jung-Eun Kim, MD
• Jonathan Kim, PMHNP-BC
• Jone Kim, DDS
• Judy Eunjoo Kim
• Myoung Su Kim
• Peter Ung Kwon Kim, D.D.S.

• Occupational Therapist in Brea, CA
• Providers in Brea, CA by specialty
• Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2022; 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.