Active NPI
Diana Kim, O.D.
- Optometrist
- Riverside, CA
National Provider Identifier
1528460904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 15101 TLG
- Practice address
- 2051 Galleria at Tyler
Riverside, CA 92503-4143 - Phone
- (951) 352-1090
- Fax
- (951) 352-1195
- NPI assigned
- Sep 17, 2014
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 15101 TLG | CA | Primary |
Addresses
Primary practice location
2051 Galleria at Tyler
Riverside, CA 92503-4143
Mailing address
201 W Broadway
#213
Anaheim, CA 92805-3879
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 |
|---|---|---|---|
| 15101 TLG | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414454400000",
"number": "1528460904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 W BROADWAY",
"address_2": "#213",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928053879"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2051 GALLERIA AT TYLER",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925034143",
"telephone_number": "951-352-1090",
"fax_number": "951-352-1195"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "DIANA",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-17",
"last_updated": "2014-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "15101 TLG",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 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.