Provider Demographics
NPI:1336130525
Name:KIM, CHRISTIAN K (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:K
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 E ST
Mailing Address - Street 2:SUITE 285
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2850
Mailing Address - Country:US
Mailing Address - Phone:145-454-5565
Mailing Address - Fax:415-454-3358
Practice Address - Street 1:901 E ST
Practice Address - Street 2:SUITE 285
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2850
Practice Address - Country:US
Practice Address - Phone:145-454-5565
Practice Address - Fax:415-454-3358
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG83836207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G83836Medicaid
CA00G83836Medicaid
CAG48435Medicare UPIN
CAG83836Medicare ID - Type Unspecified