Active NPI
Charles D Kim, O.D.
- Corneal and Contact Management Optometrist
- Palmdale, CA
National Provider Identifier
1518004688
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Corneal and Contact Management Optometrist
- License
- 9163T
- Practice address
- 40130 10TH St W
Palmdale, CA 93551-3005 - Phone
- (661) 547-1601
- NPI assigned
- Jan 30, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Corneal and Contact Management Optometrist | 152WC0802X | 9163T | CA | Primary |
Addresses
Primary practice location
40130 10TH St W
Palmdale, CA 93551-3005
Mailing address
552 Hacienda Dr
Palmdale, CA 93551-7813
Phone (661) 547-1601
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9163T | CA | MD | Corneal and Contact Management Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399852800000",
"number": "1518004688",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "552 HACIENDA DR",
"city": "PALMDALE",
"state": "CA",
"postal_code": "935517813",
"telephone_number": "661-547-1601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40130 10TH ST W",
"city": "PALMDALE",
"state": "CA",
"postal_code": "935513005",
"telephone_number": "661-547-1601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "CHARLES",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-30",
"last_updated": "2014-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "CA",
"license": "9163T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palmdale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.