Justin King, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

5679 Issued in MN

Practice address

2530 Horizon Dr
Burnsville, MN 55337-3091

Phone

(651) 209-8640

Fax

(651) 209-8690

NPI assigned

Oct 22, 2013

Last updated

Oct 2, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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.

Specialty

Clinical Psychologist

Education

Other, 2012

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mrs Acquisition Corporation

  dba Metropolitain Rehabilitation Services

  • Psychologist
  • Bloomington, MN
  • NPI 1497599724
  NPD Authorized official
• Learning and Language Specialists, Inc.

  • Clinical Neuropsychologist
  • Minneapolis, MN
  • NPI 1912022336
  NPD (past)
• Woodworth Psychological Services, LLC

  dba Learning and Language Specialists

  • Clinical Psychologist
  • Golden Valley, MN
  • NPI 1699289926
  NPD (past)

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

{
    "created_epoch": "1382400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538438400000",
    "number": "1356779771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2530 HORIZON DR",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553373091",
            "telephone_number": "651-209-8640",
            "fax_number": "651-209-8690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 HORIZON DR",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553373091",
            "telephone_number": "651-209-8640",
            "fax_number": "651-209-8690"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1405 Lilac Dr N",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Golden Valley",
            "state": "MN",
            "postal_code": "554224535",
            "country_code": "US",
            "telephone_number": "763-545-7708",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KING",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-10-22",
        "last_updated": "2018-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "5679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356779771",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Asa B Kim, M.D.
• Selina E Kim
• Sunny S Kim, M.D.
• Kind Autism Care Inc
• Andrew King, DPT
• Margaret King, LADC
• Samantha King
• Kiran Agarwal Kingsley, DDS, MS
• Amanda Jo Kingzett, PA-C
• Ashlee Kinzel, PHARM D

• Clinical Psychologist in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.