Active NPI
Yeirim Kim
- Clinical Psychologist
- Waterford, MI
National Provider Identifier
1548803463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6362009970
- Practice address
- 5619 Cooley Lake Rd
Waterford, MI 48327-3016 - Phone
- (248) 396-6765
- NPI assigned
- Oct 23, 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | MI | ||
| Clinical Psychologist | 103TC0700X | 6362009970 | MI | Primary |
Addresses
Primary practice location
5619 Cooley Lake Rd
Waterford, MI 48327-3016
Mailing address
7243 Ideal Ter
Waterford, MI 48329-2835
Phone (248) 396-6765
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 |
|---|---|---|---|
| 6362009970 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724025600000",
"number": "1548803463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7243 IDEAL TER",
"city": "WATERFORD",
"state": "MI",
"postal_code": "483292835",
"telephone_number": "248-396-6765"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5619 COOLEY LAKE RD",
"city": "WATERFORD",
"state": "MI",
"postal_code": "483273016",
"telephone_number": "248-396-6765"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "YEIRIM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-23",
"last_updated": "2024-08-19",
"certification_date": "2024-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "MI",
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6362009970",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterford, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.