Active NPI
Kimseng Soung
- Clinical Social Worker
- San Jose, CA
National Provider Identifier
1568586972
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- ASW 12599
- Practice address
- 828 S Bascom Ave Ste 100
San Jose, CA 95128-2652 - Phone
- (408) 793-5959
- NPI assigned
- Mar 19, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | ASW 12599 | CA | Primary |
Addresses
Primary practice location
828 S Bascom Ave Ste 100
San Jose, CA 95128-2652
Mailing address
828 S Bascom Ave Ste 100
San Jose, CA 95128-2652
Phone (408) 793-5959
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 |
|---|---|---|---|
| ASW 12599 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620777600000",
"number": "1568586972",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "828 S BASCOM AVE STE 100",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951282652",
"telephone_number": "408-793-5959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "828 S BASCOM AVE STE 100",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951282652",
"telephone_number": "408-793-5959"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUNG",
"first_name": "KIMSENG",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-19",
"last_updated": "2021-05-12",
"certification_date": "2021-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "ASW 12599",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.