Individual provider Active NPI

Irene Minjee Kim, OD

  • Optometrist
  • City of Industry, CA
National Provider Identifier
1699391631
Registry record updated Jan 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
34547 Issued in CA
Practice address
17550 Castleton St
City of Industry, CA 91748-1701
Phone
(626) 581-1899
NPI assigned
Jun 24, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 34547 CA Primary

Addresses

Primary practice location

17550 Castleton St
City of Industry, CA 91748-1701

Mailing address

1249 S Diamond Bar Blvd # 358
Diamond Bar, CA 91765-4122

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221014002213 CA Practitioner - Optometry 2163849977 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spectrum Eyecare Optometry IncGroup PAC ID 5193821353, 8 clinicians

Practice addresses (Care Compare)

425 W Bonita Ave
Suite 110B
San Dimas, CA 91773-2541
Phone (909) 394-0462

Merit-based Incentive Payment System (MIPS)

Final score
71.38 of 100Reported as group
Quality
22.76
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34547CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Spectrum Eyecare Optometry Inc Optometrist CurrentSince Jul 2, 2022 Accepting new patients
Dpmotikonrca LLC CurrentSince Jul 2, 2022 Accepting new patients

Locations

425 W Bonita Ave
Ste 110B
San Dimas, CA 91773
Phone (909) 394-0462

1335 N Waterman Ave
Sn Bernrdno, CA 92404
Phone (562) 867-0811

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1592956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768003200000",
    "number": "1699391631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1249 S DIAMOND BAR BLVD # 358",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917654122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17550 CASTLETON ST",
            "city": "CITY OF INDUSTRY",
            "state": "CA",
            "postal_code": "917481701",
            "telephone_number": "626-581-1899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "IRENE",
        "middle_name": "MINJEE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-24",
        "last_updated": "2026-01-10",
        "certification_date": "2026-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in City of Industry, CA

Sources for this page

Verify at the official NPI Registry.