Arizona Glaucoma Specialists - North Phoenix, LLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

35715 Issued in AZ

Legal business name

ARIZONA GLAUCOMA SPECIALISTS - NORTH PHOENIX, LLC

Practice address

20940 N Tatum Blvd
Suite 250
Phoenix, AZ 85050-7246

Phone

(480) 538-7075

Fax

(480) 538-7952

NPI assigned

Apr 15, 2014

Last updated

Sep 29, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Max Chung Ho Kim, M.D.NPI 1851300461

Title

President

Phone

(480) 538-7075

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Interoperability endpoints

• Direct secure messaging: mkim@azgsnp.intellechartdirect.net

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Max Chung Ho Kim, MD

  • Glaucoma Specialist (Ophthalmology) Physician
  • Phoenix, AZ
  • NPI 1851300461
  Medicare reassignment NPD Authorized official
• Alisha Rhea Fajardo-Diaz, O.D.

  • Optometrist
  • Chandler, AZ
  • NPI 1831328764
  Medicare reassignment NPD
• David Kay, M.D.

  • Glaucoma Specialist (Ophthalmology) Physician
  • Mesa, AZ
  • NPI 1487067484
  Medicare reassignment NPD
• Jonathan Michael Kay, O.D.

  • Optometrist
  • Tucson, AZ
  • NPI 1770136798
  Medicare reassignment NPD
• Jeffrey S Kay, MD

  • Glaucoma Specialist (Ophthalmology) Physician
  • Tucson, AZ
  • NPI 1073601274
  Medicare reassignment

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

{
    "created_epoch": "1397520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411948800000",
    "number": "1245659531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20940 N TATUM BLVD",
            "address_2": "SUITE 250",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850507246",
            "telephone_number": "480-538-7075",
            "fax_number": "480-538-7952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20940 N TATUM BLVD",
            "address_2": "SUITE 250",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850507246",
            "telephone_number": "480-538-7075",
            "fax_number": "480-538-7952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA GLAUCOMA SPECIALISTS - NORTH PHOENIX, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-15",
        "last_updated": "2014-09-29",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "MAX",
        "authorized_official_middle_name": "CHUNG HO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "480-538-7075",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "AZ",
            "license": "35715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ophthalmology Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Ophthalmology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.