Individual provider Active NPI

Roseanne Kim, LMFT

  • Marriage & Family Therapist
  • Woodland, CA
National Provider Identifier
1730116526
Registry record updated Nov 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MFC 40643 Issued in CA
Practice address
1207 Fairchild CT
Woodland, CA 95695-4321
Phone
(530) 668-2600
Fax
(530) 669-5627
NPI assigned
Jun 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MFC 40643 CA Primary

Addresses

Primary practice location

1207 Fairchild CT
Woodland, CA 95695-4321

Mailing address

3400 Data Dr
Rancho Cordova, CA 95670-7956

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
I20231214002436 CA Practitioner - Marriage and Family Therapist 9133578222 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dignity Health Medical FoundationGroup PAC ID 7810800661, 1,211 clinicians

Practice addresses (Care Compare)

1207 Fairchild CT
Woodland, CA 95695-4321
Phone (530) 666-1631

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MFC 40643CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Dignity Health Medical Foundation CurrentSince Jan 2, 2024 Accepting new patients
Dignity Health Medical Foundation Current Accepting new patients
Dignity Health Medical Foundation CurrentSince Jan 2, 2024 Accepting new patients

Locations

3400 Data Dr
Rncho Cordova, CA 95670
Phone (916) 379-2726

632 W Gibson Rd
Woodland, CA 95695
Phone (530) 666-1631

1207 Fairchild Ct
Woodland, CA 95695
Phone (530) 406-2900

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": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700092800000",
    "number": "1730116526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 DATA DR",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956707956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1207 FAIRCHILD CT",
            "city": "WOODLAND",
            "state": "CA",
            "postal_code": "956954321",
            "telephone_number": "530-668-2600",
            "fax_number": "530-669-5627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "ROSEANNE",
        "name_prefix": "Ms.",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-27",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC 40643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodland, CA

Sources for this page

Verify at the official NPI Registry.