Active NPI
Jesse Kim, DPT
- Physical Therapist
- Reno, NV
National Provider Identifier
1912490194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3744
- Practice address
- 6410 S Virginia St
Reno, NV 89511-1103 - Phone
- (775) 322-5757
- NPI assigned
- Jun 12, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 3744 | NV | Primary |
Addresses
Primary practice location
6410 S Virginia St
Reno, NV 89511-1103
Mailing address
2900 Charlevoix Dr SE Ste 200
Grand Rapids, MI 49546-7086
Phone (616) 975-5000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3744 | NV | MD | Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528761600000",
"number": "1912490194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2900 CHARLEVOIX DR SE STE 200",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495467086",
"telephone_number": "616-975-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6410 S VIRGINIA ST",
"city": "RENO",
"state": "NV",
"postal_code": "895111103",
"telephone_number": "775-322-5757"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JESSE",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-12",
"last_updated": "2018-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NV",
"license": "3744",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Reno, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 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.