Active NPI
Heawon Kim, OD
- Optometrist
- Boston, MA
National Provider Identifier
1912517707
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT5643
- Practice address
- 83 Newbury St
Boston, MA 02116-3284 - Phone
- (508) 658-7444
- NPI assigned
- Aug 5, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 34584TLG | CA | |
| Optometrist | 152W00000X | OPT5643 | MA | Primary |
Addresses
Primary practice location
83 Newbury St
Boston, MA 02116-3284
Mailing address
83 Newbury St
Boston, MA 02116-3284
Other practice location 1
9850 Genesee Ave Ste 310
LA Jolla, CA 92037-1208
Phone (800) 898-2020
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 |
|---|---|---|---|
| 34584TLG | CA | MD | Optometrist |
| OPT5643 | MA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699401600000",
"number": "1912517707",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "83 NEWBURY ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021163284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "83 NEWBURY ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021163284",
"telephone_number": "508-658-7444"
}
],
"practiceLocations": [
{
"address_1": "9850 Genesee Ave Ste 310",
"address_purpose": "LOCATION",
"city": "LA Jolla",
"state": "CA",
"postal_code": "920371208",
"country_code": "US",
"telephone_number": "800-898-2020",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIM",
"first_name": "HEAWON",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-05",
"last_updated": "2023-11-08",
"certification_date": "2023-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "34584TLG",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MA",
"license": "OPT5643",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.