Haley Kim, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

ATI4521 Issued in OR

Practice address

4880 NE 104TH Ave
Portland, OR 97220-3348

Phone

(503) 432-8452

Fax

(503) 432-8402

NPI assigned

May 29, 2019

Sex

Female

Sole proprietor

No

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 OR

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

Specialty

Optometry

Education

Pacific University - College of Optometry, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

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.

• Parkrose Vision, LLC

  • Clinic/Center
  • Portland, OR
  • NPI 1144847260
  Medicare reassignment NPD Authorized official
• M. Kwon. P.C., Inc.

  • Optometrist
  • Portland, OR
  • NPI 1770727059
  Medicare reassignment NPD

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

{
    "created_epoch": "1559088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716336000000",
    "number": "1104483833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4880 NE 104TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972203348",
            "telephone_number": "503-432-8452",
            "fax_number": "503-432-8402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4880 NE 104TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972203348",
            "telephone_number": "503-432-8452",
            "fax_number": "503-432-8402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "HALEY",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-29",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "ATI4521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric N Kim, DDS
• Evelyn Kim, M.D.
• Gemma K Kim, LCSW
• Gina Kim, PHARMD
• Grace Kim, MD
• Hannah Kim
• Helen H. Kim, O.D.
• Hewha Kim, MSW
• Hyeyeon Kim, ND. LAC
• Hyon Soo Harold Kim, MD

• Optometrist in Portland, OR
• Providers in Portland, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.