Individual provider Active NPI

Stan S Kim

  • Marriage & Family Therapist
  • Los Angeles, CA
National Provider Identifier
1902935646
Registry record updated Feb 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
LMFT49039 Issued in CA
Practice address
355 N la Brea Ave
Los Angeles, CA 90036-2517
Phone
(310) 301-7396
Fax
(310) 828-5165
NPI assigned
Mar 5, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X LMFT49039 CA Primary

Addresses

Primary practice location

355 N la Brea Ave
Los Angeles, CA 90036-2517

Mailing address

5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631

Other practice location 1

6305 Woodman Ave
Van Nuys, CA 91401-2346
Phone (818) 908-4999

Other practice location 2

2001 Santa Monica Blvd Ste 860W
Santa Monica, CA 90404-2189
Phone (310) 301-7396

Other practice location 3

11980 San Vicente Blvd Ste 102
Los Angeles, CA 90049-5012
Phone (310) 301-7396

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20240130003388 CA Practitioner - Marriage and Family Therapist 2860845427 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Regents of the University of California Los AngelesGroup PAC ID 4587857727, 84 clinicians

Practice addresses (Care Compare)

1801 Wilshire Blvd
Santa Monica, CA 90403-5609
Phone (310) 319-5098

2001 Santa Monica Blvd
Suite 860W
Santa Monica, CA 90404-2189
Phone (310) 301-7396

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LMFT49039CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California Los Angeles CurrentSince Jan 1, 2024 Accepting new patients

Locations

5767 W Century Blvd
Ste 400
Los Angeles, CA 90045
Phone (310) 301-5200

File 2939
Los Angeles, CA 90074
Phone (310) 794-6596

11980 San Vicente Blvd
Ste 102
Los Angeles, CA 90049
Phone (310) 208-7777

1801 Wilshire Blvd
Santa Monica, CA 90403
Phone (310) 319-5098

2001 Santa Monica Blvd
Ste 860W
Santa Monica, CA 90404
Phone (310) 586-9097

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707264000000",
    "number": "1902935646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 N LA BREA AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900362517",
            "telephone_number": "310-301-7396",
            "fax_number": "310-828-5165"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6305 Woodman Ave",
            "address_purpose": "LOCATION",
            "city": "Van Nuys",
            "state": "CA",
            "postal_code": "914012346",
            "country_code": "US",
            "telephone_number": "818-908-4999",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2001 Santa Monica Blvd Ste 860W",
            "address_purpose": "LOCATION",
            "city": "Santa Monica",
            "state": "CA",
            "postal_code": "904042189",
            "country_code": "US",
            "telephone_number": "310-301-7396",
            "fax_number": "310-828-5165",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11980 San Vicente Blvd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900495012",
            "country_code": "US",
            "telephone_number": "310-301-7396",
            "fax_number": "310-828-5165",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "STAN",
        "middle_name": "S",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-05",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT49039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.