Johnny Kim

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

93241 Issued in CA

Practice address

204 Hampton Drive
Venice, CA 90291

Phone

(310) 396-6468

NPI assigned

Oct 20, 2016

Reactivated

Mar 4, 2021

Last updated

Aug 25, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Clear View Behavioral Services

  • Marriage & Family Therapist
  • Redlands, CA
  • NPI 1396117388
  NPD

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

{
    "created_epoch": "1476921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629849600000",
    "number": "1568913820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 HAMPTON DRIVE",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "90291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 HAMPTON DRIVE",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "90291",
            "telephone_number": "310-396-6468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JOHNNY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-10-20",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "deactivation_date": "2020-04-05",
        "reactivation_date": "2021-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "93241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiphavee Ketlek
• Kevin Kunkel and Associates, Therapy for Adults and Children
• Golara Khandan, DMD
• John Khoe, DDS
• Yamalieu Khuu
• Kimberly Taylor Family Therapist, a Prof. Corp.
• Kinetiq Physical Therapy Inc
• Coley M King, D.O.
• Summer Brianne King
• Flynn Louise Klace

• Clinical Social Worker in Venice, CA
• Providers in Venice, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.