Active NPI
Mi Soon Kim, O.D.
- Optometrist
- Pleasanton, CA
National Provider Identifier
1710905898
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT 13033
- Practice address
- 4725 1St St Ste 270
Pleasanton, CA 94566-7136 - Phone
- (925) 249-9642
- Fax
- (925) 249-9643
- NPI assigned
- Jul 17, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | OPT 13033 | CA | Primary |
Addresses
Primary practice location
4725 1St St Ste 270
Pleasanton, CA 94566-7136
Mailing address
4725 1St St Ste 270
Pleasanton, CA 94566-7136
Phone (925) 249-9642
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 |
|---|---|---|---|
| OPT 13033 | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Luxottica of America Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710905898",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4725 1ST ST STE 270",
"city": "PLEASANTON",
"state": "CA",
"postal_code": "945667136",
"telephone_number": "925-249-9642",
"fax_number": "925-249-9643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4725 1ST ST STE 270",
"city": "PLEASANTON",
"state": "CA",
"postal_code": "945667136",
"telephone_number": "925-249-9642",
"fax_number": "925-249-9643"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MI SOON",
"name_prefix": "Mrs.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT 13033",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pleasanton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.