Healthcare Provider Details

I. General information

NPI: 1255277745
Provider Name (Legal Business Name): DR. JANE O. KIM PSYCHOLOGICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39812 MISSION BLVD STE 106
FREMONT CA
94539-3087
US

IV. Provider business mailing address

39812 MISSION BLVD STE 106
FREMONT CA
94539-3087
US

V. Phone/Fax

Practice location:
  • Phone: 650-294-8018
  • Fax:
Mailing address:
  • Phone: 650-294-8018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JANE O KIM
Title or Position: PRESIDENT
Credential: PHD
Phone: 650-294-8018