Jinse Kim, PHD, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0701008862 Issued in VA

Practice address

14631 Lee Hwy Ste 313
Centreville, VA 20121-5834

Phone

(703) 650-9099

NPI assigned

Nov 6, 2019

Last updated

Sep 23, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1572998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695427200000",
    "number": "1821632431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6538 CREEK RUN DR",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201213865",
            "telephone_number": "703-531-9401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14631 LEE HWY STE 313",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201215834",
            "telephone_number": "703-650-9099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JINSE",
        "credential": "PHD, LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-11-06",
        "last_updated": "2023-09-23",
        "certification_date": "2023-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701008862",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LC10007",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Desktops",
            "affiliation": "N",
            "address_1": "14631 Lee Hwy Ste 313",
            "city": "Centreville",
            "state": "VA",
            "country_code": "US",
            "postal_code": "201215834",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Desktops",
            "affiliation": "N",
            "address_1": "14631 Lee Hwy Ste 313",
            "city": "Centreville",
            "state": "VA",
            "country_code": "US",
            "postal_code": "201215834",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Desktops",
            "affiliation": "N",
            "address_1": "14631 Lee Hwy Ste 313",
            "city": "Centreville",
            "state": "VA",
            "country_code": "US",
            "postal_code": "201215834",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Desktops",
            "affiliation": "N",
            "address_1": "14631 Lee Hwy Ste 313",
            "city": "Centreville",
            "state": "VA",
            "country_code": "US",
            "postal_code": "201215834",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "desktop",
            "affiliation": "N",
            "address_1": "14631 Lee Hwy Ste 313",
            "city": "Centreville",
            "state": "VA",
            "country_code": "US",
            "postal_code": "201215834",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Dong Hee Kim, LCSW
• Hongki Kim, D.C.
• Hyojin Kim
• Ie Rae Kim
• Jennifer Carolyn Kim, M.ED. CCC-SLP
• Joshua Kim, DO
• Kyung M Kim, OTR
• Seok Ju Kim
• Song Jin Sophie Kim, PA
• Thomas S. Kim, D.D.S.

• Professional Counselor in Centreville, VA
• Providers in Centreville, VA by specialty
• Professional Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.