Amanda Kim, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

33503 Issued in CA

Practice address

1560 Brookhollow Dr Ste 212
Santa Ana, CA 92705-5411

Phone

(714) 386-9171

NPI assigned

Aug 11, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2016

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Meridian Counseling

  • Marriage & Family Therapist
  • Los Angeles, CA
  • NPI 1396202206
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1439251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662076800000",
    "number": "1689050809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 BROOKHOLLOW DR STE 212",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927055411",
            "telephone_number": "714-386-9171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1560 BROOKHOLLOW DR STE 212",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927055411",
            "telephone_number": "714-386-9171"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9432 Alderbury St",
            "address_purpose": "LOCATION",
            "city": "Cypress",
            "state": "CA",
            "postal_code": "906302850",
            "country_code": "US",
            "telephone_number": "949-444-9047",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "AMANDA",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-11",
        "last_updated": "2022-09-02",
        "certification_date": "2022-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "33503",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "CA",
            "license": "33503",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "CA",
            "license": "33503",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "33503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kia Ramezani, DDS Inc.
• Dana C Kiesling
• Phong Kieu, NP
• Shannon Kilgore, LMFT
• Alice H Kim, LMFT
• Ann Kim, MSN, MPH, CNS
• Anna Kim, PA-C
• Anna Ula Kim, R.N., PHN
• Austin Kim, BEHAVIOR TECHNICAN
• Bouree Kim

• Clinical Psychologist in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.