Active NPI
Joan Kim, OT
- Occupational Therapist
- Dallas, TX
National Provider Identifier
1720631328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 119961
- Practice address
- 6301 Gaston Ave Ste 750
Dallas, TX 75214 - Phone
- (214) 295-5374
- NPI assigned
- Jul 23, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 119961 | TX | Primary |
Addresses
Primary practice location
6301 Gaston Ave Ste 750
Dallas, TX 75214
Mailing address
4606 Cedar Springs Rd Apt 1725
Dallas, TX 75219-7209
Phone (414) 429-0712
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 119961 | TX | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563840000000",
"number": "1720631328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4606 CEDAR SPRINGS RD APT 1725",
"city": "DALLAS",
"state": "TX",
"postal_code": "752197209",
"telephone_number": "414-429-0712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6301 GASTON AVE STE 750",
"city": "DALLAS",
"state": "TX",
"postal_code": "75214",
"telephone_number": "214-295-5374"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JOAN",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-23",
"last_updated": "2019-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "119961",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.