Active NPI
Jessica K Kim, PSYD
- Clinical Psychologist
- Seattle, WA
National Provider Identifier
1679978589
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY61320770
- Practice address
- 200 W Mercer St # E305
Seattle, WA 98119-3995 - Phone
- (206) 589-1018
- NPI assigned
- Nov 4, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Case Manager/Care Coordinator | 171M00000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Clinical Psychologist | 103TC0700X | PSY61320770 | WA | Primary |
Addresses
Primary practice location
200 W Mercer St # E305
Seattle, WA 98119-3995
Mailing address
21081 S Western Ave Ste 295
Torrance, CA 90501-1707
Phone (310) 533-6600
Other practice location 1
21081 S Western Ave Ste 295
Torrance, CA 90501-1707
Phone (310) 533-6600
Other practice location 2
4335 Atlantic Ave
Long Beach, CA 90807-2803
Phone (562) 219-4900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 28, 2023 through Jun 28, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY61320770 | WA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Los Angeles County Department of Mental Health | Past | Accepting new patients | |
| Relational Psych, PLLC | Mental Health | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Torrance, CA
- NPI 1184842148
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1415059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710374400000",
"number": "1679978589",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21081 S WESTERN AVE STE 295",
"city": "TORRANCE",
"state": "CA",
"postal_code": "905011707",
"telephone_number": "310-533-6600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 W MERCER ST # E305",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981193995",
"telephone_number": "206-589-1018"
}
],
"practiceLocations": [
{
"address_1": "21081 S Western Ave Ste 295",
"address_purpose": "LOCATION",
"city": "Torrance",
"state": "CA",
"postal_code": "905011707",
"country_code": "US",
"telephone_number": "310-533-6600",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4335 Atlantic Ave",
"address_purpose": "LOCATION",
"city": "Long Beach",
"state": "CA",
"postal_code": "908072803",
"country_code": "US",
"telephone_number": "562-219-4900",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIM",
"first_name": "JESSICA",
"middle_name": "K",
"name_prefix": "Miss",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-11-04",
"last_updated": "2024-03-14",
"certification_date": "2024-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PSY61320770",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; 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.