Cerritos Eye Medical Center, Inc.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

G96402 Issued in CA

Legal business name

CERRITOS EYE MEDICAL CENTER, INC.

Practice address

11829 South St
Suite 202
Cerritos, CA 90703-6828

Phone

(562) 402-4720

Fax

(562) 402-9231

NPI assigned

Jun 26, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Tae Sun Kim, M.D.NPI 1366578049

Title

Owner/President

Phone

(562) 402-4720

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tae Sun Kim, M.D.

  • Ophthalmology Physician
  • Cerritos, CA
  • NPI 1366578049
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195084800000",
    "number": "1598792889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11829 SOUTH ST",
            "address_2": "SUITE 202",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907036828",
            "telephone_number": "562-402-4720",
            "fax_number": "562-402-9231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11829 SOUTH ST",
            "address_2": "SUITE 202",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907036828",
            "telephone_number": "562-402-4720",
            "fax_number": "562-402-9231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CERRITOS EYE MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2007-11-15",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "TAE",
        "authorized_official_middle_name": "SUN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "562-402-4720",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "G96402",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "A87753",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "WA87753C",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A877530",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0091370",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Cerritos Family Denal Center
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• Cerritos Medical Center, Inc
• Cerritos Physical Therapy & Rehabilitation, Inc.
• Cerritos Residence Care Inc.

• Ophthalmology Physician in Cerritos, CA
• Providers in Cerritos, CA by specialty
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.