Individual provider Active NPI

Minkyo Jeon, LMFT

  • Marriage & Family Therapist
  • Los Angeles, CA
National Provider Identifier
1700513876
Registry record updated Sep 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
155020 Issued in CA
Practice address
1968 W Adams Blvd # 101
Los Angeles, CA 90018-3515
Phone
(323) 731-3534
Fax
(323) 731-5618
NPI assigned
Aug 8, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 20596 CA
Marriage & Family Therapist 106H00000X 155020 CA Primary

Addresses

Primary practice location

1968 W Adams Blvd # 101
Los Angeles, CA 90018-3515

Mailing address

1968 W Adams Blvd # 101
Los Angeles, CA 90018-3515
Phone (323) 731-3534

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250929001351 CA Practitioner - Marriage and Family Therapist 6406352590 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Special Service for Groups IncGroup PAC ID 2769396886, 61 clinicians

Practice addresses (Care Compare)

1968 W Adams Blvd
Suite 101And106
Los Angeles, CA 90018-3515
Phone (323) 731-3534

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
20596CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Special Service for Groups, Inc. CurrentSince Jul 4, 2025 Accepting new patients
Special Service for Groups, Inc. CurrentSince Jul 4, 2025 Accepting new patients
Special Service for Groups, Inc. Current Accepting new patients

Locations

905 E 8th St
Los Angeles, CA 90021
Phone (213) 553-1800

1968 W Adams Blvd
Ste 101106
Los Angeles, CA 90018
Phone (323) 731-3534

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1659916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759190400000",
    "number": "1700513876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1968 W ADAMS BLVD # 101",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900183515",
            "telephone_number": "323-731-3534",
            "fax_number": "323-731-5618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1968 W ADAMS BLVD # 101",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900183515",
            "telephone_number": "323-731-3534",
            "fax_number": "323-731-5618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEON",
        "first_name": "MINKYO",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-08",
        "last_updated": "2025-09-30",
        "certification_date": "2025-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CA",
            "license": "20596",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "155020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.