Taeryeng Gim, CDPT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LH61428482 Issued in WA

Practice address

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

Phone

(360) 805-3122

NPI assigned

Jun 21, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Della Kim Professional name

Medicare fee-for-service enrollment

Enrolled in WA

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

Specialty

Mental Health Counselor

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

International Community Health ServicesGroup PAC ID 5799695672, 95 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• International Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Seattle, WA
  • NPI 1376659151
  Medicare reassignment Care Compare group NPD
• International Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Bellevue, WA
  • NPI 1114363157
  NPD
• International Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Auburn, WA
  • NPI 1831910439
  NPD

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

{
    "created_epoch": "1529539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689033600000",
    "number": "1992299069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34703",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14090 FRYLNDS BLVD SE STE 347",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982722760",
            "telephone_number": "360-805-3122"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9930 Evergreen Way Ste Z150",
            "address_purpose": "LOCATION",
            "city": "Everett",
            "state": "WA",
            "postal_code": "982043889",
            "country_code": "US",
            "telephone_number": "425-347-5152",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIM",
        "first_name": "TAERYENG",
        "credential": "CDPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-21",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP61044121",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LH61428482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DELLA",
            "last_name": "KIM",
            "credential": "CDPT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jennifer Gess, PH.D., LCPC, LMHC
• Rebecca Claire Gianotti, O.D.
• Amanda Gilkeson
• Kristen Gill, MD
• Kyle David Gill, DDS
• Clarissa Jones Ginger, MA, LMHC
• Rosemarie A Glaser, LMP
• Gold Bar Chiropractic P.L.L.C
• Golden Years Smiles LLC
• Melissa Dawn Goldsmith, LMP

• Mental Health Counselor in Monroe, WA
• Providers in Monroe, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.