DR. JACK SON KIM O.D.
NPI 1679808356
Optometrist in Buena Park, CA

Q: What is Jack Kim's NPI number?

The NPI number for Jack Kim is 1679808356. It was assigned to this individual provider in the NPPES registry on October 13, 2009.

Q: What is Jack Kim's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Q: When was this NPI record last updated?

The NPPES record for Jack Kim was last updated on May 29, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 13, 2009PECOS Enrolled

5832 BEACH BLVD UNIT 109, BUENA PARK, CA 90621(714) 228-1888(714) 676-8308 Get Directions Write a Review

NPPES record last updated: May 29, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: May 29, 2026, Jan 9, 2025 (2 updates tracked since 2025).

On this page

About Dr. Jack Son Kim O.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JACK SON KIM O.D. (NPI 1679808356) is an individual optometrist in Buena Park, California, licensed in California (13848) and active in the NPI registry since October 2009. He is enrolled in Medicare PECOS and maintains a secondary practice location in Artesia.

NPPES Registry Identity

NPI1679808356

Entity TypeIndividualMale

Primary Taxonomy152W00000X

Provider Legal NameDR. JACK SON KIMCredential: O.D.

Location Address5832 BEACH BLVD UNIT 109Buena Park, CA 90621-5500

Mailing Address6495 Saipan StCypress, CA 90630-5620 · (626) 388-7391

Phone(714) 228-1888

Fax(714) 676-8308

Sole ProprietorNo

Enumeration DateOctober 13, 2009

Last NPPES UpdateMay 29, 20262 updates tracked since enumeration

NPPES CertifiedMay 29, 2026

✔ NPI 1679808356 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers

Taxonomy Code152W00000X

License✔ Licensed in CA · 13848

Definition

Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

5832 BEACH BLVD UNIT 109, Buena Park, CA 90621

Open in Google Maps ↗

Secondary Practice Location 1

Location 119038 Norwalk BlvdArtesia, CA 90701-7032 · Phone (562) 653-9500 · Fax (562) 653-9513

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Jack Son Kim O.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Jack Kim reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Eyecare Medical Corporation

Same address

Ophthalmology

5832 BEACH BLVD UNIT 109
Buena Park, CA 90621

Reassigned Medicare billing, California enrollment
11 clinicians in this Medicare group

NPI 1427016120 (714) 228-1888

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 90621 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$142.39 typical visit price

range $62.96 – $187.60

Typical copayment $35.59 (range $15.74 – $46.90)

Most-billed visit code 99204

Established Patient

$77.96 typical visit price

range $20.84 – $153.61

Typical copayment $19.49 (range $5.21 – $38.40)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ALEJANDRA UCHIO M.D.

Ophthalmology

5832 BEACH BLVD UNIT 109
BUENA PARK, CA 90621

Orange County (714) 228-1888

EUGENE Y CHANG MD

Ophthalmology (Retina Specialist)

5832 BEACH BLVD UNIT 109
BUENA PARK, CA 90621

Orange County (714) 228-1888

EYECARE MEDICAL CORPORATION

Ophthalmology

5832 BEACH BLVD UNIT 109
BUENA PARK, CA 90621

Orange County (714) 228-1888

DR. ERICA DANIELLE BARANWAL O.D.

Optometrist

5832 BEACH BLVD UNIT 109
BUENA PARK, CA 90621

Orange County (714) 228-1888

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack Kim's NPI number?

The NPI number for Jack Kim is 1679808356. It was assigned to this individual provider in the NPPES registry on October 13, 2009.

Where is Jack Kim located?

Jack Kim practices at 5832 Beach Blvd Unit 109, Buena Park, CA 90621. The listed phone number is (714) 228-1888.

What is Jack Kim's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Jack Kim enrolled in Medicare?

Yes. Jack Kim is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jack Kim's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jack Kim reassigns Medicare benefits to Eyecare Medical Corporation (Buena Park, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jack Kim's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jack Kim accept?

Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Providence Health Plan list Jack Kim as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jack Kim was last updated on May 29, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.