Individual provider Active NPI

Grace Za Kim, MD

  • Ophthalmology Physician
  • Columbus, OH
National Provider Identifier
1003870643
Registry record updated Dec 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
35038852K Issued in OH
Practice address
245 Taylor Station Rd
Columbus, OH 43213-4400
Phone
(614) 861-0448
Fax
(614) 861-7717
NPI assigned
Apr 12, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 13, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 35038852K OH Primary

Addresses

Primary practice location

245 Taylor Station Rd
Columbus, OH 43213-4400

Mailing address

245 Taylor Station Rd
Columbus, OH 43213-4400
Phone (614) 861-0448

Other identifiers 1

IdentifierTypeStateIssuer
0333099MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120530000615 OH Practitioner - Ophthalmology 0345403341 Practice locations: Columbus, OH

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35038852KOHMDOphthalmology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323734400000",
    "number": "1003870643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 TAYLOR STATION RD",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432134400",
            "telephone_number": "614-861-0448",
            "fax_number": "614-861-7717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 TAYLOR STATION RD",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432134400",
            "telephone_number": "614-861-0448",
            "fax_number": "614-861-7717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "GRACE",
        "middle_name": "ZA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-12",
        "last_updated": "2011-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "OH",
            "license": "35038852K",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0333099",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.