Active NPI
Yoon Kim
- Physical Therapist
- Modesto, CA
National Provider Identifier
1356907331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT292427
- Practice address
- 1303 Mable Ave
Modesto, CA 95355 - Phone
- (408) 891-0739
- NPI assigned
- May 14, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT60981356 | WA | |
| Physical Therapist | 225100000X | PT292427 | CA | Primary |
Addresses
Primary practice location
1303 Mable Ave
Modesto, CA 95355
Mailing address
38532 Royal Ann CMN
Fremont, CA 94536-4216
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT292427 | CA | MD | Physical Therapist |
| PT60981356 | WA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588809600000",
"number": "1356907331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38532 ROYAL ANN CMN",
"city": "FREMONT",
"state": "CA",
"postal_code": "945364216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1303 MABLE AVE",
"city": "MODESTO",
"state": "CA",
"postal_code": "95355",
"telephone_number": "408-891-0739"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "YOON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-14",
"last_updated": "2020-05-07",
"certification_date": "2020-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT60981356",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT292427",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.