Individual provider Active NPI

Christian K Kim, MD

  • Ophthalmology Physician
  • San Rafael, CA
National Provider Identifier
1336130525
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
G83836 Issued in CA
Practice address
901 E St
Suite 285
San Rafael, CA 94901-2850
Phone
(145) 454-5565
Fax
(415) 454-3358
NPI assigned
Nov 4, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X G83836 CA Primary

Addresses

Primary practice location

901 E St
Suite 285
San Rafael, CA 94901-2850

Mailing address

901 E St
Suite 285
San Rafael, CA 94901-2850
Phone (145) 454-5565

Other identifiers 1

IdentifierTypeStateIssuer
00G83836MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080116000828 CA Practitioner - Ophthalmology 4789688045 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Saint Louis University School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

901 E St
Suite 285
San Rafael, CA 94901-2850
Phone (415) 454-5565

Merit-based Incentive Payment System (MIPS)

Final score
22.42 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
74.73

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery90

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G83836CAMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Marin Ophthalmic Consultants, a Medical Corporation CurrentSince Feb 1, 2008 Accepting new patients
Marin Ophthalmic Consultants CurrentSince Feb 1, 2008 Accepting new patients

Locations

165 Rowland Way
Ste 207
Novato, CA 94945
Phone (415) 454-5565

901 E St
Ste 270
San Rafael, CA 94901
Phone (415) 454-2112

901 E St
Ste 285
San Rafael, CA 94901
Phone (415) 454-5565

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: christian.kim.p1@direct.marineyes.nextgenshare.com

Organizations & group practices 2

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": "1131062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1336130525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 E ST",
            "address_2": "SUITE 285",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012850",
            "telephone_number": "145-454-5565",
            "fax_number": "415-454-3358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 E ST",
            "address_2": "SUITE 285",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012850",
            "telephone_number": "145-454-5565",
            "fax_number": "415-454-3358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "CHRISTIAN",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-04",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "G83836",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G83836",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

Verify at the official NPI Registry.