Henri Dong-Ha Kim, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

11903TLG Issued in CA

Practice address

1919 Davis St
San Leandro, CA 94577-1208

Phone

(510) 430-9908

NPI assigned

Mar 19, 2007

Last updated

Apr 1, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617235200000",
    "number": "1861516478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 MANOR DR",
            "city": "PIEDMONT",
            "state": "CA",
            "postal_code": "946114144",
            "telephone_number": "510-435-3462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 DAVIS ST",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945771208",
            "telephone_number": "510-430-9908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "HENRI",
        "middle_name": "DONG-HA",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-19",
        "last_updated": "2021-04-01",
        "certification_date": "2021-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11903TLG",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11903T",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Killgore
• Sarah Killingsworth
• Tyrone Kilson
• Dayna Annie Kim, DPM
• Diana Kim
• Hyunjoon Kim, DDS
• Ina Kim, DDS
• Jiyoon Kim
• Jorge Kim, MD
• Julie Ji Kim, LCSW

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.