Individual provider Active NPI

Kia Yang, OD

  • Optometrist
  • Shiprock, NM
National Provider Identifier
1124687884
Registry record updated Feb 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3643 Issued in MN
Practice address
US Hwy 491 North
Shiprock, NM 87420
Phone
(505) 368-6001
Fax
(505) 368-7411
NPI assigned
Jun 6, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3643 MN Primary

Addresses

Primary practice location

US Hwy 491 North
Shiprock, NM 87420

Mailing address

1136 Albemarle St
Saint Paul, MN 55117-4415
Phone (505) 368-6001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, MN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20190817000047 TX Practitioner - Optometry 9335477140 Reassigns benefits to 1 organization
I20210401002073 MN Practitioner - Optometry 9335477140 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

2500 Como Ave
Saint Paul, MN 55108-1460
Phone (651) 641-6200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3643MNMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. CurrentSince May 16, 2022 Accepting new patients
Optometric Services, LLC Optometrist CurrentSince Jan 27, 2021 Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Jul 26, 2019 Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Jul 26, 2019 Accepting new patients
Group Health, Inc. CurrentSince May 16, 2022 Accepting new patients

Locations

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

2500 Como Ave
Saint Paul, MN 55108
Phone (651) 641-6200

2716 Lincoln Dr
Saint Paul, MN 55113
Phone (651) 631-9394

1891 Robert St S
West St Paul, MN 55118
Phone (651) 451-1805

1980 Robert St S
West St Paul, MN 55118
Phone (651) 451-1805

Interoperability endpoints

  • Direct secure messaging: kyang284104@direct.healthpartners.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1559779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613952000000",
    "number": "1124687884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1136 ALBEMARLE ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551174415",
            "telephone_number": "505-368-6001",
            "fax_number": "505-368-7411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "US HWY 491 NORTH",
            "city": "SHIPROCK",
            "state": "NM",
            "postal_code": "87420",
            "telephone_number": "505-368-6001",
            "fax_number": "505-368-7411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YANG",
        "first_name": "KIA",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-06",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shiprock, NM

Sources for this page

Verify at the official NPI Registry.