Active NPI
Christopher Kim
- Clinical Psychologist
- Glendora, CA
National Provider Identifier
1750117586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 94028524
- Practice address
- 415 W Route 66 Ste 202
Glendora, CA 91740-4335 - Phone
- (626) 963-4467
- NPI assigned
- Sep 9, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 94028524 | CA | Primary |
Addresses
Primary practice location
415 W Route 66 Ste 202
Glendora, CA 91740-4335
Mailing address
1201 Porto Grande Unit 3
Diamond Bar, CA 91765-5414
Phone (949) 529-0234
Other practice location 1
2705 S Diamond Bar Blvd Ste 238
Diamond Bar, CA 91765-3554
Phone (626) 963-4467
Other practice location 2
27201 Puerta Real Ste 300
Mission Viejo, CA 92691-8590
Phone (949) 291-0038
Other practice location 3
1161 E Covina Blvd
Covina, CA 91724-1523
Phone (800) 654-2673
Other names 1
- Chris Kim
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 |
|---|---|---|---|
| 94028524 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1725840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740009600000",
"number": "1750117586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 PORTO GRANDE UNIT 3",
"city": "DIAMOND BAR",
"state": "CA",
"postal_code": "917655414",
"telephone_number": "949-529-0234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 W ROUTE 66 STE 202",
"city": "GLENDORA",
"state": "CA",
"postal_code": "917404335",
"telephone_number": "626-963-4467"
}
],
"practiceLocations": [
{
"address_1": "2705 S Diamond Bar Blvd Ste 238",
"address_purpose": "LOCATION",
"city": "Diamond Bar",
"state": "CA",
"postal_code": "917653554",
"country_code": "US",
"telephone_number": "626-963-4467",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "27201 Puerta Real Ste 300",
"address_purpose": "LOCATION",
"city": "Mission Viejo",
"state": "CA",
"postal_code": "926918590",
"country_code": "US",
"telephone_number": "949-291-0038",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1161 E Covina Blvd",
"address_purpose": "LOCATION",
"city": "Covina",
"state": "CA",
"postal_code": "917241523",
"country_code": "US",
"telephone_number": "800-654-2673",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIM",
"first_name": "CHRISTOPHER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-09-09",
"last_updated": "2025-02-20",
"certification_date": "2025-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "94028524",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "CHRIS",
"last_name": "KIM",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Glendora, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.