Provider Demographics
NPI:1336292721
Name:KIM, JULIE LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:LEE
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 1:7100 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3063
Mailing Address - Country:US
Mailing Address - Phone:818-786-0796
Mailing Address - Fax:
Practice Address - Street 1:7100 VAN NUYS BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3063
Practice Address - Country:US
Practice Address - Phone:818-786-0796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9773T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU39951Medicare UPIN