GRACE KIM
NPI 1770161465
Optometrist in Los Angeles, CA
About Grace Kim NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
GRACE KIM (NPI 1770161465) is an individual optometrist in Los Angeles, California, licensed in California (35031TLG) and active in the NPI registry since April 2021. She is enrolled in Medicare PECOS, maintains a secondary practice location in North Hills, and is a graduate of Illinois College Of Optometry At Chicago (2021).
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Grace Kim is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
2Medicare enrollment records show Grace Kim reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Los Angeles, CA 90025
- Reassigned Medicare billing, California enrollment
- 6 clinicians in this Medicare group
Los Angeles, CA 90034
- Reassigned Medicare billing, California enrollment
- 13,921 clinicians in this Medicare group
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 90025 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Grace Kim's NPI number?
The NPI number for Grace Kim is 1770161465. It was assigned to this individual provider in the NPPES registry on April 1, 2021.
Where is Grace Kim located?
Grace Kim practices at 11540 Santa Monica Blvd Ste 202, Los Angeles, CA 90025. The listed phone number is (310) 473-5464.
What is Grace Kim's specialty?
The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.
Is Grace Kim enrolled in Medicare?
Yes. Grace Kim is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Grace Kim's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Grace Kim reassigns Medicare benefits to 2 organizations: (Los Angeles, CA) and Southern California Permanente Medical Group (Los Angeles, CA). Each 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 Grace Kim's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Grace Kim was last updated on June 23, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Grace Kim · NPI 1770161465
Optometrist provider in Los Angeles, California. Individual provider, active in the CMS NPPES registry since April 1, 2021.
## Identity
- **NPI:** 1770161465 (Entity type: Individual)
- **Enumerated:** April 1, 2021
- **Primary specialty:** Optometrist · taxonomy 152W00000X
- **State license:** 35031TLG (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 11540 SANTA MONICA BLVD STE 202, Los Angeles, CA 90025-7905
- **Phone:** (310) 473-5464
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): (NPI 1306971429, Los Angeles, CA); Southern California Permanente Medical Group (NPI 1043242563, Los Angeles, CA) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Illinois College Of Optometry At Chicago, class of 2021
## Record status
- **NPPES last updated:** June 23, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1770161465) · Data from the CMS NPPES public registry.