Virgil Kim

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MG60172608 Issued in WA

Practice address

14090 Fryelands Blvd SE Ste 347
Monroe, WA 98272-2760

Phone

(360) 805-3122

Fax

(360) 805-9180

NPI assigned

Dec 1, 2010

Last updated

Jun 16, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Dong Wan Kim Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1291161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529107200000",
    "number": "1881996551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14090 FRYELANDS BLVD SE STE 347",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982722760",
            "telephone_number": "360-805-3122",
            "fax_number": "360-805-9180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14090 FRYELANDS BLVD SE STE 347",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982722760",
            "telephone_number": "360-805-3122",
            "fax_number": "360-805-9180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "VIRGIL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-12-01",
        "last_updated": "2018-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "60795326",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WA",
            "license": "MG60172608",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881996551",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DONG WAN",
            "last_name": "KIM",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Kneading Hands Massage Therapy, LLC (Monroe Medical Massage)
• Huai-Che Ko, LMHC
• Philip Franklin Kogler, D.C.
• Negin Kourehpazan, DNP

• Marriage & Family Therapist in Monroe, WA
• Providers in Monroe, WA by specialty
• Marriage & Family Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.