Individual provider Active NPI

Kimberly Nicole Javier, PHD

  • Psychologist
  • San Jose, CA
National Provider Identifier
1528356227
Registry record updated Jun 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY33131 Issued in CA
Practice address
2400 Moorpark Ave Ste 300
San Jose, CA 95128-2680
Phone
(408) 975-2730
NPI assigned
Jul 14, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X
Mental Health Counselor 101YM0800X PSB94024136 CA
Psychologist 103T00000X PSY33131 CA Primary

Addresses

Primary practice location

2400 Moorpark Ave Ste 300
San Jose, CA 95128-2680

Mailing address

2400 Moorpark Ave Ste 300
San Jose, CA 95128-2680
Phone (408) 975-2730

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20220318002155 CA Practitioner - Clinical Psychologist 2860887338 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSB94024136CAMDMental Health Counselor
PSY33131CAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Asian Americans for Community Involvement of Santa Clara County, Inc CurrentSince Mar 11, 2022 Accepting new patients
Asian Americans for Community Involvement of Santa Clara County, Inc CurrentSince Mar 11, 2022 Accepting new patients
Alliant International University Past Accepting new patients

Locations

266 N Jackson Ave
Ste 4
San Jose, CA 95116
Phone (408) 975-2763

749 Story Rd
Ste 50
San Jose, CA 95122

2400 Moorpark Ave
Ste 300
San Jose, CA 95128
Phone (408) 975-2763

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1310601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1528356227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 MOORPARK AVE STE 300",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951282680",
            "telephone_number": "408-975-2730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 MOORPARK AVE STE 300",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951282680",
            "telephone_number": "408-975-2730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAVIER",
        "first_name": "KIMBERLY",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-14",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "PSB94024136",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY33131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.