Jong Yoon Kim

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY36465 Issued in CA

Practice address

11721 Telegraph Rd
Santa Fe Springs, CA 90670-3674

Phone

(562) 949-8455

NPI assigned

Jul 19, 2021

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

Enrolled in CA

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.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pacific ClinicsGroup PAC ID 4082008420, 72 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

• Pacific Clinics

  • Community/Behavioral Health Agency
  • Campbell, CA
  • NPI 1255496105
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1626652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771286400000",
    "number": "1518530443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1052 SECO ST APT 203",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911032852",
            "telephone_number": "650-274-6534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11721 TELEGRAPH RD",
            "city": "SANTA FE SPRINGS",
            "state": "CA",
            "postal_code": "906703674",
            "telephone_number": "562-949-8455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JONG YOON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-19",
        "last_updated": "2026-02-17",
        "certification_date": "2026-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "225C00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY36465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Keaton
• Dan Reid Kerkhoff
• Kevin J. Pelton MD, Inc.
• Mehwish Awan Khan, M.D.
• Haeni Kim
• Joshua Kim
• Nahee Kim
• Christopher Kinai
• Travis Kincaid
• Nikita Klimashov

• Clinical Psychologist in Santa Fe Springs, CA
• Providers in Santa Fe Springs, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2026; 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.