Active NPI
Gina E. Kim, OD
- Optometrist
- Houston, TX
National Provider Identifier
1306832936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 5253T
- Practice address
- 1229 Campbell Rd
Houston, TX 77055-6401 - Phone
- (713) 467-6600
- Fax
- (713) 467-7914
- NPI assigned
- Sep 20, 2005
- Sex
- Female
- Sole proprietor
- No
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 | 5253T | TX | Primary |
Addresses
Primary practice location
1229 Campbell Rd
Houston, TX 77055-6401
Mailing address
2855 Gramercy St
Houston, TX 77025-1756
Phone (713) 668-6828
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 104405902 | Medicaid | TX |
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 |
|---|---|---|---|
| 5253T | TX | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310947200000",
"number": "1306832936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2855 GRAMERCY ST",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770251756",
"telephone_number": "713-668-6828",
"fax_number": "713-558-8785"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1229 CAMPBELL RD",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770556401",
"telephone_number": "713-467-6600",
"fax_number": "713-467-7914"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "GINA",
"middle_name": "E.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-20",
"last_updated": "2011-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TX",
"license": "5253T",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "104405902",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.