Individual provider Active NPI

Young Min Chung, OD

  • Optometrist
  • Kirkland, WA
National Provider Identifier
1790410637
Registry record updated Jul 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD61572417 Issued in WA
Practice address
12911 120TH Ave NE Ste A40
Kirkland, WA 98034-3075
Phone
(425) 643-2020
NPI assigned
Jul 22, 2022
Last updated
Jul 19, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OD61572417 WA Primary

Addresses

Primary practice location

12911 120TH Ave NE Ste A40
Kirkland, WA 98034-3075

Mailing address

11721 NE 117TH CT Apt 629
Kirkland, WA 98034-5227
Phone (206) 228-6781

Other practice location 1

1837 156th Ave NE Ste 201
Bellevue, WA 98007-4387
Phone (425) 643-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20241003001803 WA Practitioner - Optometry 8325424708 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Overlake Eyecare P SGroup PAC ID 4284521170, 5 clinicians

Practice addresses (Care Compare)

1837 156TH Ave NE
Suite 201
Bellevue, WA 98007-4387
Phone (425) 643-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OD61572417WAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Overlake Eyecare P S Optometrist CurrentSince Sep 1, 2024 Accepting new patients
America's Best Contacts and Eyeglasses PastSince Jul 1, 2022 Accepting new patients

Locations

1837 156th Ave NE
Ste 201
Bellevue, WA 98007
Phone (425) 629-0496

12911 120th Ave NE
Ste A40
Kirkland, WA 98034
Phone (425) 821-1800

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, 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": "1658448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752883200000",
    "number": "1790410637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11721 NE 117TH CT APT 629",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980345227",
            "telephone_number": "206-228-6781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12911 120TH AVE NE STE A40",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343075",
            "telephone_number": "425-643-2020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1837 156th Ave NE Ste 201",
            "address_purpose": "LOCATION",
            "city": "Bellevue",
            "state": "WA",
            "postal_code": "980074387",
            "country_code": "US",
            "telephone_number": "425-643-2020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHUNG",
        "first_name": "YOUNG MIN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-22",
        "last_updated": "2025-07-19",
        "certification_date": "2025-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD61572417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

Verify at the official NPI Registry.