Provider Demographics
NPI:1083813315
Name:KIM, EUGENE CHONGKON (OD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:CHONGKON
Last Name:KIM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2795 W LINCOLN AVE STE L
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6334
Mailing Address - Country:US
Mailing Address - Phone:714-527-5060
Mailing Address - Fax:714-527-5073
Practice Address - Street 1:2795 W LINCOLN AVE STE L
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-6334
Practice Address - Country:US
Practice Address - Phone:714-527-5060
Practice Address - Fax:714-527-5073
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13309152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACD249AOtherMEDICARE GROUP PTAN
CACS429ZMedicare PIN
CACD249AOtherMEDICARE GROUP PTAN
CASD0133090Medicare PIN