Active NPI
Lulu Y Kim, OD
- Optometrist
- Tustin, CA
National Provider Identifier
1194878744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 11036T
- Practice address
- 2530 Bryan Ave
Suite D
Tustin, CA 92782-8916 - Phone
- (714) 838-2020
- NPI assigned
- Jan 18, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 11036T | CA | Primary |
Addresses
Primary practice location
2530 Bryan Ave
Suite D
Tustin, CA 92782-8916
Mailing address
2530 Bryan Ave
Ste D
Tustin, CA 92782-8916
Phone (714) 404-1917
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11036 | CA | MD | Mental Health Counselor |
| 11036T | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476230400000",
"number": "1194878744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2530 BRYAN AVE",
"address_2": "STE D",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927828916",
"telephone_number": "714-404-1917"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2530 BRYAN AVE",
"address_2": "SUITE D",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927828916",
"telephone_number": "714-838-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "LULU",
"middle_name": "Y",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-18",
"last_updated": "2016-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "11036T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tustin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.