Active NPI
Samuel K Kim, MFT ASSOCIATE
- Marriage & Family Therapist
- El Monte, CA
National Provider Identifier
1811544935
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 120878
- Practice address
- 3208 Rosemead Blvd Ste 100
El Monte, CA 91731-2830 - Phone
- (626) 227-7001
- NPI assigned
- Aug 22, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Marriage & Family Therapist | 106H00000X | 120878 | CA | Primary |
Addresses
Primary practice location
3208 Rosemead Blvd Ste 100
El Monte, CA 91731-2830
Mailing address
3208 Rosemead Blvd Ste 200
El Monte, CA 91731-2830
Phone (626) 227-7001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 10, 2024 through Nov 10, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 120878 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601078400000",
"number": "1811544935",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3208 ROSEMEAD BLVD STE 200",
"city": "EL MONTE",
"state": "CA",
"postal_code": "917312830",
"telephone_number": "626-227-7001",
"fax_number": "626-227-7015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3208 ROSEMEAD BLVD STE 100",
"city": "EL MONTE",
"state": "CA",
"postal_code": "917312830",
"telephone_number": "626-227-7001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SAMUEL",
"middle_name": "K",
"credential": "MFT ASSOCIATE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-22",
"last_updated": "2020-09-26",
"certification_date": "2020-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "120878",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Monte, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.