Fanette Kim, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC4519 Issued in FL

Practice address

11921 N Dale Mabry Hwy
Tampa, FL 33609

Phone

(813) 963-1008

NPI assigned

Aug 20, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fanette P. Kim O.D. PLLC

  • Optometrist
  • Tampa, FL
  • NPI 1154286490
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1282262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448409600000",
    "number": "1104132786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11921 N DALE MABRY HWY",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33609",
            "telephone_number": "813-963-1008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11921 N DALE MABRY HWY",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33609",
            "telephone_number": "813-963-1008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "FANETTE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-20",
        "last_updated": "2015-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC4519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Vincent Kiluk, MD
• Vinita C Kiluk, M.D.
• Christopher Kim
• Dae Won Kim, M.D.
• Esther Youngmi Kim, RD
• Hyon Jeong Kim, MD
• Hyonwoo Adam Kim, CPO
• Jennifer Kim, PHARMD
• Jin Kim
• Jin M. Kim, D.O.

• Optometrist in Tampa, FL
• Providers in Tampa, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.