Provider Demographics
NPI:1255466850
Name:KIM, SHIN (OD)
Entity Type:Individual
Prefix:DR
First Name:SHIN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2527 CLIFFSIDE LN NW
Mailing Address - Street 2:#Y304
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-6832
Mailing Address - Country:US
Mailing Address - Phone:714-785-7657
Mailing Address - Fax:
Practice Address - Street 1:2219 S 37TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7473
Practice Address - Country:US
Practice Address - Phone:253-671-6012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4089TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist