Carolyn C Kim, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

11404TPA Issued in CA

Practice address

607 N Central Ave
Suite 105
Glendale, CA 91203-1804

Phone

(818) 956-1010

Fax

(818) 543-6083

NPI assigned

Dec 28, 2005

Last updated

Mar 5, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Carolyn Wang Former name

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Southern College of Optometry, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Usc Care Medical Group IncGroup PAC ID 0446157747, 1,378 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Usc Care Medical Group, Inc

  • General Practice Physician
  • Los Angeles, CA
  • NPI 1902846306

  Optometrist

  Medicare reassignment Care Compare group NPD
• James McCaffery MD a Professional Corp

  dba Glendale Eye Medical Group

  • Ophthalmology Physician
  • Glendale, CA
  • NPI 1710962865
  NPD
• James McCaffery MD a Professional Corp

  dba Glendale Eye Medical Group, Inc.

  • Ophthalmology Physician
  • Sylmar, CA
  • NPI 1750580940
  NPD
• Usc Care Medical Group, Inc

  dba Fair Oaks Clinic

  • Durable Medical Equipment & Medical Supplies
  • Pasadena, CA
  • NPI 1427937390
  NPD
• Glendale Optometric Center

  • Optometrist
  • Glendale, CA
  • NPI 1801093653
  NPD (past)

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

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1467439836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 N CENTRAL AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "91203",
            "telephone_number": "818-956-1010",
            "fax_number": "818-543-6083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 N CENTRAL AVE",
            "address_2": "SUITE 105",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912031804",
            "telephone_number": "818-956-1010",
            "fax_number": "818-543-6083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "CAROLYN",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-28",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11404TPA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ75843Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROLYN",
            "last_name": "WANG",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Aimee Kyungsun Kim
• Annie Ahhyun Kim, PHARMD
• Ashlynne Kim, OD
• Bo Eun Kim, PA
• Candace Kim
• Changho Kim
• Charles J Kim, DDS
• David Soo Hyun Kim, M.D.
• Deborah Kim
• Dong Kim, D.C.

• Optometrist in Glendale, CA
• Providers in Glendale, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.