Active NPI
Jenny H. Kim, O.D.
- Optometrist
- Nellis Afb, NV
National Provider Identifier
1548427800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 611
- Practice address
- 4700 Las Vegas Blvd N
Attention: Credentialing
Nellis Afb, NV 89191-6600 - Phone
- (702) 644-6002
- Fax
- (702) 644-6003
- NPI assigned
- May 22, 2008
- 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 | 611 | NV | Primary |
Addresses
Primary practice location
4700 Las Vegas Blvd N
Attention: Credentialing
Nellis Afb, NV 89191-6600
Mailing address
5260 Island Chain Rd
Las Vegas, NV 89118-1364
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 611 | NV | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211414400000",
"number": "1548427800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5260 ISLAND CHAIN RD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891181364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4700 LAS VEGAS BLVD N",
"address_2": "ATTENTION: CREDENTIALING",
"city": "NELLIS AFB",
"state": "NV",
"postal_code": "891916600",
"telephone_number": "702-644-6002",
"fax_number": "702-644-6003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JENNY",
"middle_name": "H.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-22",
"last_updated": "2008-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NV",
"license": "611",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nellis Afb, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.