Active NPI
Jin Ah Renee Kim, LCSW
- Clinical Social Worker
- Beaverton, OR
National Provider Identifier
1619098316
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 12655 SW Center St
Suite # 470
Beaverton, OR 97005-1600 - Phone
- (971) 808-8226
- NPI assigned
- Apr 2, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | OR | ||
| Clinical Social Worker | 1041C0700X | OR | Primary |
Addresses
Primary practice location
12655 SW Center St
Suite # 470
Beaverton, OR 97005-1600
Mailing address
PO Box 19737
Portland, OR 97280
Phone (971) 808-8226
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473206400000",
"number": "1619098316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 19737",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97280",
"telephone_number": "971-808-8226"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12655 SW CENTER ST",
"address_2": "SUITE # 470",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970051600",
"telephone_number": "971-808-8226"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JIN AH",
"middle_name": "RENEE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-02",
"last_updated": "2016-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OR",
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.