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HAN SOO KIM MA
NPI 1033761408
Counselor - Mental Health in Lynnwood, WA

Active since July 15, 2019PECOS EnrolledAccepts Medicare Assignment
4629 168TH ST SW STE E, LYNNWOOD, WA 98037(425) 776-1290 Get Directions Write a Review

NPPES record last updated: November 29, 2022. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Nov 29, 2022, Jul 15, 2019 (2 updates tracked since 2019).

About Han Soo Kim Ma NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HAN SOO KIM MA (NPI 1033761408) is an individual mental health provider in Lynnwood, Washington, licensed in Washington (LH60971499) and active in the NPI registry since July 2019. He is enrolled in Medicare PECOS, maintains a secondary practice location in Lakewood, and is a graduate of Other (1999).

NPPES Registry Identity

NPI1033761408
Entity TypeIndividualMale
Primary Taxonomy101YM0800X
Provider Legal NameHAN SOO KIMCredential: MA
Location Address4629 168TH ST SW STE ELynnwood, WA 98037-8640
Mailing Address9102 Bridgeport Way SwLakewood, WA 98499-2418 · (253) 302-3826
Phone(425) 776-1290
Sole ProprietorYes
Medical School CMSOtherGraduated 1999
Enumeration DateJuly 15, 2019
Last NPPES UpdateNovember 29, 20222 updates tracked since enumeration
NPPES CertifiedNovember 29, 2022
✔ NPI 1033761408 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in WA · LH60971499
4629 168TH ST SW STE E, Lynnwood, WA 98037
Open in Google Maps ↗

Secondary Practice Location 1

Location 19102 Bridgeport Way SWLakewood, WA 98499-2418 · Phone (253) 302-3826

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Premera Blue Cross Blue Shield of Alaska.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Han Soo Kim Ma is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9638520505
PECOS Enrollment IDI20240105000414
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Han Soo Kim reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Mindful Therapy Group PC
3.2 mi
Clinical
6505 216TH ST SW STE 100
Mountlake Terrace, WA 98043
  • Reassigned Medicare billing, Washington enrollment
  • 777 clinicians in this Medicare group
NPI 1316238678 (425) 640-7009

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

YOHAN CHUNG
Counselor (Addiction (Substance Use Disorder))
4629 168TH ST SW STE E
LYNNWOOD, WA 98037
Snohomish County (425) 776-1290
MINJUNG KOO
Counselor
4629 168TH ST SW STE E
LYNNWOOD, WA 98037
Snohomish County (425) 776-1290
SANGMI YIM
Student in an Organized Health Care Education/Training Program
4629 168TH ST SW STE E
LYNNWOOD, WA 98037
Snohomish County (425) 776-1290
HEEJUNG PARK SUDPT
Counselor (Mental Health)
4629 168TH ST SW STE E
LYNNWOOD, WA 98037
Snohomish County (253) 652-9975
JIHYUN PARK
Counselor (Addiction (Substance Use Disorder))
4629 168TH ST SW STE E
LYNNWOOD, WA 98037
Snohomish County (425) 776-1290
EDEN YEBIN CHO
Counselor
4629 168TH ST SW STE E
LYNNWOOD, WA 98037
Snohomish County (425) 776-1290
OKRAN YI
Student in an Organized Health Care Education/Training Program
4629 168TH ST SW STE E
LYNNWOOD, WA 98037
Snohomish County (425) 776-1290
JINSIK CHO MSW
Social Worker
4629 168TH ST SW STE E
LYNNWOOD, WA 98037
Snohomish County (425) 776-1290

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Han Soo Kim's NPI number?

The NPI number for Han Soo Kim is 1033761408. It was assigned to this individual provider in the NPPES registry on July 15, 2019.

Where is Han Soo Kim located?

Han Soo Kim practices at 4629 168th St SW Ste E, Lynnwood, WA 98037. The listed phone number is (425) 776-1290.

What is Han Soo Kim's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Han Soo Kim enrolled in Medicare?

Yes. Han Soo Kim is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Han Soo Kim's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Han Soo Kim reassigns Medicare benefits to Mindful Therapy Group PC (Mountlake Terrace, WA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Han Soo Kim's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Han Soo Kim accept?

Health plans from Ambetter Health and Premera Blue Cross Blue Shield of Alaska list Han Soo Kim as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Han Soo Kim was last updated on November 29, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.