Active NPI
Jennie Jeongwon Kim
- Clinical Social Worker
- Los Angeles, CA
National Provider Identifier
1609528660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 96148
- Practice address
- 510 S Vermont Ave FL 22
Los Angeles, CA 90020-1992 - Phone
- (213) 738-2877
- NPI assigned
- Jan 21, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 | 96148 | CA | Primary |
Addresses
Primary practice location
510 S Vermont Ave FL 22
Los Angeles, CA 90020-1992
Mailing address
PO Box 70153
Los Angeles, CA 90020
Phone (213) 738-2877
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 |
|---|---|---|---|
| 96148 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742256000000",
"number": "1609528660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 70153",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90020",
"telephone_number": "213-738-2877"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 S VERMONT AVE FL 22",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900201992",
"telephone_number": "213-738-2877"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JENNIE",
"middle_name": "JEONGWON",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-01-21",
"last_updated": "2025-03-18",
"certification_date": "2025-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "96148",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.