Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jacky Jaeok Kim

Individual provider Clinical Social Worker · NPI 1790506665

Jacky Jaeok Kim is a Clinical Social Worker in Eugene, Oregon. Qualified in 2018, 8 years ago. Practices as a sole proprietor. Licensed in Oregon and Washington.

Years since qualifying
8
Licensed in
OR, WA
In the registry since
2024
Specialties on file
2

Practice location Address checks out

235 W 10th Ave
Eugene, OR 97401-3008
Phone: (541) 515-7800
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence SWI.LW.70016961 (WA)
Clinical Social Worker Taxonomy 1041C0700X · Licence L17503 (OR)

Record details

NPI number1790506665
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedOctober 22, 2024
Last updated in NPPESJune 23, 2026
Certification dateJune 23, 2026
Mailing address2620 Bellevue Way Ne # 234, Bellevue, WA 98004-2209

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Accepts Medicare assignment Not indicated

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