Elizabeth J. Kim, PH.D.
Individual provider Active NPI Psychologist · Gardengrove, CA
NPI 1669480778 · NPPES record last updated Jun 13, 2012
Key facts
- NPI
- 1669480778
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- PSY 12964 (CA)
- Practice address
- 13030 Euclid St.
Ste 118
Gardengrove, CA 92843-1334 - Phone
- (714) 537-5400
- Fax
- (714) 537-5465
- NPI assigned
- Aug 4, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2021 through Oct 1, 2027
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 12964 | CA | MD | Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY 12964 | CA | Yes |
Addresses
Primary practice location
13030 Euclid St.
Ste 118
Gardengrove, CA 92843-1334
Mailing address
13030 Euclid St
Ste 118
Garden Grove, CA 92843-1334
Phone (714) 537-5400
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.