Active NPI
Young C Kim, O.D.
- Optometrist
- Milford, MA
National Provider Identifier
1972660439
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4146
- Practice address
- 250 Fortune Blvd
Milford, MA 01757-1743 - Phone
- (508) 478-5604
- Fax
- (508) 478-5639
- NPI assigned
- Jan 3, 2007
- Sex
- Male
- 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 | 4146 | MA | Primary |
Addresses
Primary practice location
250 Fortune Blvd
Milford, MA 01757-1743
Mailing address
250 Fortune Blvd
Milford, MA 01757-1743
Phone (508) 473-1042
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0317730 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111115000485 | MA | Practitioner - Optometry | 8123292844 | Practice locations: Milford, MA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316736000000",
"number": "1972660439",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 FORTUNE BLVD",
"city": "MILFORD",
"state": "MA",
"postal_code": "017571743",
"telephone_number": "508-473-1042",
"fax_number": "508-473-1058"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 FORTUNE BLVD",
"city": "MILFORD",
"state": "MA",
"postal_code": "017571743",
"telephone_number": "508-478-5604",
"fax_number": "508-478-5639"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "YOUNG",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-03",
"last_updated": "2011-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MA",
"license": "4146",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0317730",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2011; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.