Tiffany Kim, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3607ATI Issued in OR

Practice address

10480 SW Eastridge St Apt 37
Portland, OR 97225-5042

Phone

(408) 805-0354

NPI assigned

Oct 10, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Pacific University - College of Optometry, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Truvision Eye Care LLC

  • Optometrist
  • Tacoma, WA
  • NPI 1639613706
  Medicare reassignment Authorized official
• Stuart a Terry MD PA

  • Ophthalmology Physician
  • San Antonio, TX
  • NPI 1558336412
  NPD (past)

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

{
    "created_epoch": "1349827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442966400000",
    "number": "1467704791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25699 SW ARGYLE AVE A",
            "address_2": "LENZA EYE CENTER",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970705798",
            "telephone_number": "503-833-2662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10480 SW EASTRIDGE ST APT 37",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255042",
            "telephone_number": "408-805-0354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "TIFFANY",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-10",
        "last_updated": "2015-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3607ATI",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sohyon Kim
• Song Jin Sunny Kim, MD
• Soonie Ann Kim, PHD
• Stephanie Kim
• Tae Yeon Kim, MD
• Yongsung Kim, MD
• Yoon-Jin Kim
• Young Jin Kim, RN
• Younghee Kim, DNP
• Yuna Kim

• Optometrist in Portland, OR
• Providers in Portland, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2015; 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.