Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1487095501 Deactivated / Inactive NPI Female Practitioner

Dr. Jacqueline Kim , PhD

Psychologist • Orange, CA

✓ Accepts Medicare Assignment
⚠️

Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Jacqueline Kim has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date July 17, 2013
NPI Deactivation Date May 28, 2021
Total Practice Duration ~4 Years of Practice (2017 – 2021)

Professional Overview & Biography Verified Profile Summary

Dr. Jacqueline Kim, PhD was a registered Psychologist in Orange, CA. Prior to record deactivation on 2021-05-28, Dr. Kim completed approximately 4 years of clinical practice following graduation from University Of Michigan Medical School in 2017.

Dr. Kim was affiliated with Uc Regents and accepted Medicare assignment.

Practice Location & Contact Primary Location

Practice Address

101 The City Dr S

Orange, CA 928683201

Telephone 7144568000
Associated Practice Facility / Clinic
🏢 The Department Of Psychiatry Facility NPI 1831159003

Medicare Profile & Education

Medical School

University Of Michigan Medical School

Graduation Year

2017

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Psychologist in Orange, CA

Experienced Practitioner (5-10 Yrs)
Practitioner Clinical Experience
9 Yrs -17.2 yrs vs City Avg
City Avg: 26.2 Yrs
State Avg: 24.2 Yrs
Regional Practice Density
89 Specialists

Practicing in Orange, CA (7695 Statewide)

Telehealth Adoption Rate
4.5% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Kim (9 Years) 9 Yrs
Orange Specialty Average (26.2 Years) 26.2 Yrs

Medical Specialties & State Licenses

CMS Verified: 2025-10-09
Psychologist Primary Specialty

NUCC Taxonomy Code: 103T00000X

State License CA 32623

A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.

Psychologist - Clinical

NUCC Taxonomy Code: 103TC0700X

State License CA 32623

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

Hospital & Practice Group Affiliations

Uc Regents

101 The City Dr S, Orange, CA 928683201

Phone: 7144567004

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Dr. Arash Mahajerin , MD

Pediatrics - Pediatric Hematology-Oncology

NPI 1033315247

Doctor of Medicine (M.D.)

Dr. Joseph Erwin Salunday , DNP, FNP-C

Nurse Practitioner - Family

NPI 1043030869

Doctor of Nursing Practice, Family Nurse Practitioner (Certified)

Dr. Misako Nagasaka , MD

Internal Medicine - Hematology & Oncology

NPI 1063707958

Doctor of Medicine (M.D.)

Julie Smith , NP

Internal Medicine - Hematology & Oncology

NPI 1083137947

Nurse Practitioner

Dr. Virginia Fontenot , MD

Obstetrics & Gynecology

NPI 1124681812

Doctor of Medicine (M.D.)

Dr. Arash Rezazadeh Kalebasty , MD

Internal Medicine - Hematology & Oncology

NPI 1205974755

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

13 Historical Events
📍
Updated Practice Location October 09, 2025

Registered at 101 THE CITY DR S, ORANGE, CA 928683201 (Tel: 7144568000)

📍
Updated Business Mailing Address October 09, 2025

Registered at 101 THE CITY DR S, ORANGE, CA 928683201

📍
Updated Practice Location June 29, 2021

Registered at 1141 S GARFIELD AVE STE 200, ALHAMBRA, CA 918014714 (Tel: 6265882825)

📍
Updated Business Mailing Address June 29, 2021

Registered at 5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 900455631

👤
Provider Name / Credentials Updated June 29, 2021

Recorded as JACQUELINE KIM, PHD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 29, 2021

Psychologist (License #32623 in CA)

⚠️
NPI Profile Deactivated May 28, 2021

Record deactivated on May 28, 2021

NPI Profile Active July 17, 2013

NPI status registered as active in NPPES database

📍
Updated Practice Location July 17, 2013

Registered at 500 E WASHINGTON ST, SUITE 100, ANN ARBOR, MI 481042057 (Tel: 7347633471)

📍
Updated Business Mailing Address July 17, 2013

Registered at 1718 MCINTYRE ST, ANN ARBOR, MI 481052417

👤
Provider Name / Credentials Updated July 17, 2013

Recorded as HYO JU KIM

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 17, 2013

Student in an Organized Health Care Education/Training Program

🟢
Initial NPI Registration & Enumeration July 17, 2013

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

0 Reviews
No patient reviews submitted yet for Dr. Jacqueline Kim. Be the first to share your experience!

Sign in to leave a review for Dr. Jacqueline Kim

Only verified registered users can submit ratings, post feedback, and upload facility photos.

NPI Administrative Meta

NPI Number: 1487095501
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 17, 2013
Last Update: October 09, 2025
Deactivation Date: May 28, 2021
Sole Proprietor: Yes

Mailing Address

101 The City Dr S

Orange, CA 928683201

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.