Active NPI
Jiyoung Kim
- Occupational Therapist
- Henderson, NV
National Provider Identifier
1699509588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 3543
- Practice address
- 400 N Stephanie St Ste 310
Henderson, NV 89014-6608 - Phone
- (702) 454-1162
- NPI assigned
- Aug 31, 2024
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 25533 | FL | |
| Occupational Therapist | 225X00000X | 3543 | NV | Primary |
Addresses
Primary practice location
400 N Stephanie St Ste 310
Henderson, NV 89014-6608
Mailing address
6760 Kimberly Blvd
North Lauderdale, FL 33068-2545
Phone (954) 451-4100
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3543 | NV | MD | Occupational Therapist |
| 25533 | FL | MD | Home Health Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1725062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725926400000",
"number": "1699509588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6760 KIMBERLY BLVD",
"city": "NORTH LAUDERDALE",
"state": "FL",
"postal_code": "330682545",
"telephone_number": "954-451-4100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 N STEPHANIE ST STE 310",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890146608",
"telephone_number": "702-454-1162"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JIYOUNG",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-31",
"last_updated": "2024-09-10",
"certification_date": "2024-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "25533",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NV",
"license": "3543",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Henderson, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.