Jacky Jaeok Kim

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SWI.LW.70016961 Issued in WA

Practice address

235 W 10TH Ave
Eugene, OR 97401-3008

Phone

(541) 515-7800

NPI assigned

Oct 22, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Jacky Jaeok Kim Professional name

Medicare fee-for-service enrollment

Enrolled in OR

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

Specialty

Clinical Social Worker

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  OR

  Medicare reassignment NPD
• Vibrant Hues Therapy and Consultation LLC

  • Psychologist
  • Eugene, OR
  • NPI 1477286300
  NPD (past)

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

{
    "created_epoch": "1729555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782172800000",
    "number": "1790506665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 BELLEVUE WAY NE # 234",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980042209",
            "telephone_number": "504-982-4909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 W 10TH AVE",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974013008",
            "telephone_number": "541-515-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JACKY JAEOK",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-22",
        "last_updated": "2026-06-23",
        "certification_date": "2026-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "SWI.LW.70016961",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L17503",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKY JAEOK",
            "last_name": "KIM",
            "credential": "LCSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Terrence Killian, M.S.W
• Dorothy Olive Kilmer, F.N.P.
• Josie A Kilpatrick, LMT
• Ann Kim-Fuchs, BA
• Emma Kim, L.M.T.
• Jessica J Kim, PHARM D
• Sojeong Kim
• Susan Youn Kim, O.D.
• Yena Kim, FNP-BC
• Diane Marie Kimball, NP

• Clinical Social Worker in Eugene, OR
• Providers in Eugene, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.