Kellie-Anne Chiemi Ishii-Kim, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

35068 Issued in CA

Practice address

425 W Bonita Ave Ste 110B
San Dimas, CA 91773-2543

Phone

(909) 394-0462

NPI assigned

Aug 4, 2018

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in HI, CA2 enrollments

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 2

Specialty

Optometry

Education

Southern California College of Optometry, 2018

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)

Merit-based Incentive Payment System (MIPS)

Final score

71.38 of 100Reported as group

Quality

22.76

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Spectrum Eyecare Optometry Inc

  • Optometrist
  • San Dimas, CA
  • NPI 1801949573
  Medicare reassignment Care Compare group NPD
• Robb T. Shibayama, O.D., Inc.

  dba Hawaii Vision Associates

  • Optometrist
  • Pearl City, HI
  • NPI 1629125752
  Medicare reassignment NPD
• Wendi N Harada OD Inc

  dba Hawaii Vision Associates

  • Optometrist
  • Kaneohe, HI
  • NPI 1215266523
  Medicare reassignment NPD
• Dpmotikonrca LLC

  • Podiatrist
  • Bishop, CA
  • NPI 1285952150
  NPD
• Robb T. Shibayama, O.D., Inc

  • Optometrist
  • Aiea, HI
  • NPI 1588296578
  NPD
• Wendi N Harada OD Inc

  dba Hawaii Vision Associates

  • Optometrist
  • Kapolei, HI
  • NPI 1831449958
  NPD
• Wendi N. Harada, O.D., Inc.

  dba Hawaii Vision Associates

  • Optometrist
  • Honolulu, HI
  • NPI 1528689452
  NPD

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

{
    "created_epoch": "1533340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1710465372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 WOODPECKER ST",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928231064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 W BONITA AVE STE 110B",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917732543",
            "telephone_number": "909-394-0462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISHII-KIM",
        "first_name": "KELLIE-ANNE",
        "middle_name": "CHIEMI",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-04",
        "last_updated": "2023-03-07",
        "certification_date": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "35068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kingsley C Ijoma
• Shania C Ilagan
• Immanuel Hospice, Inc.
• Christopher Ingram
• Integrity Ssurgical Center Inc.
• Rosanna Wadie Iskander, M.D.
• Habib Ali Ismail, MD
• Marisol Isusquiza, PHARMD
• IV-Profusion
• Lanny Jachin, PT

• Optometrist in San Dimas, CA
• Providers in San Dimas, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.