Active NPI
Elizabeth J. Kim, PH.D.
- Psychologist
- Garden Grove, CA
National Provider Identifier
1669480778
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY 12964
- Practice address
- 13030 Euclid St.
Ste 118
Gardengrove, CA 92843-1334 - Phone
- (714) 537-5400
- Fax
- (714) 537-5465
- NPI assigned
- Aug 4, 2006
- Last updated
- Jun 13, 2012
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY 12964 | CA | Primary |
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
Medicare participation
Medicare enrollment files- 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
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 12964 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339545600000",
"number": "1669480778",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13030 EUCLID ST",
"address_2": "STE 118",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928431334",
"telephone_number": "714-537-5400",
"fax_number": "714-537-5465"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13030 EUCLID ST.",
"address_2": "STE 118",
"city": "GARDENGROVE",
"state": "CA",
"postal_code": "928431334",
"telephone_number": "714-537-5400",
"fax_number": "714-537-5465"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "ELIZABETH",
"middle_name": "J.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-04",
"last_updated": "2012-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY 12964",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garden Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.