Active NPI
Jaehee Kim
- Pediatric Nurse Practitioner
- Fort Worth, TX
National Provider Identifier
1356274906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 1227530
- Practice address
- 9509 N Beach St Ste 102
Fort Worth, TX 76244-6399 - Phone
- (817) 617-8600
- NPI assigned
- Jun 4, 2026
- 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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 1227530 | TX | Primary |
Addresses
Primary practice location
9509 N Beach St Ste 102
Fort Worth, TX 76244-6399
Mailing address
6967 Fallbrook CT W
Fort Worth, TX 76120-1315
Phone (704) 526-6071
Other names 1
- Jae Hee Park
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1227530 | TX | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1780531200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787529600000",
"number": "1356274906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6967 FALLBROOK CT W",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761201315",
"telephone_number": "704-526-6071"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9509 N BEACH ST STE 102",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "762446399",
"telephone_number": "817-617-8600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JAEHEE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2026-06-04",
"last_updated": "2026-08-24",
"certification_date": "2026-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Pediatrics",
"state": "TX",
"license": "1227530",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JAE",
"last_name": "PARK",
"middle_name": "HEE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.