NPIMap

Organization Active NPI

Kim Khanh Nguyen OD Inc

  • Optometrist
  • San Jose, CA
National Provider Identifier
1629470950
Registry record updated Jan 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
14282 Issued in CA
Legal business name
KIM KHANH NGUYEN OD INC
Practice address
451 Blossom Hill Rd Ste 10
San Jose, CA 95123-1658
Phone
(408) 281-3926
Fax
(408) 281-2515
NPI assigned
Sep 18, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2022

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

Authorized official

Name
Kim-Khanh NguyenNPI 1649550013
Title
Owner
Phone
(408) 281-3926

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 14282 CA Primary

Addresses

Primary practice location

451 Blossom Hill Rd Ste 10
San Jose, CA 95123-1658

Mailing address

451 Blossom Hill Rd Ste 10
San Jose, CA 95123-1658
Phone (408) 281-3926

Other names 1

  • IMAGE EYECARE OPTOMETRY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141222000643 CA Part B Supplier - Clinic/Group Practice 9830412923 Receives reassigned benefits from 2 practitioners
Practice locations: San Jose, CA

National Provider Directory

National Provider Directory

Locations

925 Blossom Hill Rd
Ste 1224
San Jose, CA 95123
Phone (408) 281-3926

451 Blossom Hill Rd
Ste 10
San Jose, CA 95123
Phone (408) 281-3926

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1410998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643155200000",
    "number": "1629470950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "451 BLOSSOM HILL RD STE 10",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951231658",
            "telephone_number": "408-281-3926",
            "fax_number": "408-281-2515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "451 BLOSSOM HILL RD STE 10",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951231658",
            "telephone_number": "408-281-3926",
            "fax_number": "408-281-2515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIM KHANH NGUYEN OD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-18",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "KIM-KHANH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "408-281-3926"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IMAGE EYECARE OPTOMETRY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "IMAGE EYECARE OPTOMETRY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; 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.