1. Home
  2. Directory
  3. Oregon
  4. Eugene
  5. Social Worker
  6. NPI Profile

JACKY JAEOK KIM
NPI 1790506665
Social Worker - Clinical in Eugene, OR

Active since October 22, 2024PECOS Enrolled
235 W 10TH AVE, EUGENE, OR 97401(541) 515-7800 Get Directions Write a Review

NPPES record last updated: June 23, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 19, 2026, Dec 30, 2024 (2 updates tracked since 2024).

About Jacky Jaeok Kim NPPES

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

JACKY JAEOK KIM (NPI 1790506665) is an individual clinical provider in Eugene, Oregon, licensed in Washington (SWI.LW.70016961) and active in the NPI registry since October 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2018).

NPPES Registry Identity

NPI1790506665
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameJACKY JAEOK KIM
Location Address235 W 10TH AVEEugene, OR 97401-3008
Mailing Address2620 Bellevue Way Ne # 234Bellevue, WA 98004-2209 · (504) 982-4909
Phone(541) 515-7800
Sole ProprietorYes
Medical School CMSOtherGraduated 2018
Enumeration DateOctober 22, 2024
Last NPPES UpdateJune 23, 20262 updates tracked since enumeration
NPPES CertifiedJune 23, 2026
✔ NPI 1790506665 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
Licenses✔ Licensed in WA · SWI.LW.70016961✔ Licensed in OR · L17503
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
235 W 10TH AVE, Eugene, OR 97401
Open in Google Maps ↗

Other Names 1

Professional Name (2)Jacky Jaeok Kim Lcsw

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacky Jaeok Kim is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID749760254
PECOS Enrollment IDI20260213003732
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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97401 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $54.96 – $166.64
Typical copayment $0.00 (range $13.74 – $41.66)
Most-billed visit code NA
Established Patient
$68.64 typical visit price
range $17.68 – $136.19
Typical copayment $17.16 (range $4.42 – $34.04)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

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

VIBRANT HUES THERAPY AND CONSULTATION LLC
Psychologist
235 W 10TH AVE
EUGENE, OR 97401
Lane County (541) 515-7800
MISS ELISA MARIA OLALDE L.M.T.
Massage Therapist
235 W 10TH AVE
EUGENE, OR 97401
Lane County (541) 683-9069

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 Jacky Jaeok Kim's NPI number?

The NPI number for Jacky Jaeok Kim is 1790506665. It was assigned to this individual provider in the NPPES registry on October 22, 2024. The provider is also known as Jacky Jaeok Kim Lcsw.

Where is Jacky Jaeok Kim located?

Jacky Jaeok Kim practices at 235 W 10th Ave, Eugene, OR 97401. The listed phone number is (541) 515-7800.

What is Jacky Jaeok Kim's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Jacky Jaeok Kim enrolled in Medicare?

Yes. Jacky Jaeok Kim is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jacky Jaeok Kim was last updated on June 23, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 43 days 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.