Paul Kim, O.D., a Professional Corporation

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

PAUL KIM, O.D., A PROFESSIONAL CORPORATION

Practice address

621 S Western Ave Ste 214
Los Angeles, CA 90005-3042

Phone

(213) 573-2012

Fax

(213) 389-1002

NPI assigned

Oct 27, 2022

Organization subpart

No

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

Authorized official

Name

Paul Kim, ODNPI 1275654857

Title

President

Phone

(630) 903-8988

Specialties & licenses 1

Addresses

Other names 1

• MASQ Optometry Doing business as

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Paul S Kim, OD

  • Optometrist
  • Irvine, CA
  • NPI 1275654857
  NPD Authorized official
• Kyu Hwan Jang, ABO

  • Optician
  • Los Angeles, CA
  • NPI 1679167878
  NPD
• Galina Vardanyan, O.D.

  • Optometrist
  • Burbank, CA
  • NPI 1467929265
  NPD (past)

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

{
    "created_epoch": "1666828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675036800000",
    "number": "1407563661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "249 LOCKFORD",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926020957",
            "telephone_number": "630-903-8988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S WESTERN AVE STE 214",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900053042",
            "telephone_number": "213-573-2012",
            "fax_number": "213-389-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL KIM, O.D., A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-27",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-903-8988",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MASQ Optometry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.