Provider Demographics
NPI:1407563661
Name:PAUL KIM, O.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PAUL KIM, O.D., A PROFESSIONAL CORPORATION
Other - Org Name:MASQ OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-903-8988
Mailing Address - Street 1:249 LOCKFORD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-0957
Mailing Address - Country:US
Mailing Address - Phone:630-903-8988
Mailing Address - Fax:
Practice Address - Street 1:621 S WESTERN AVE STE 214
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-3042
Practice Address - Country:US
Practice Address - Phone:213-573-2012
Practice Address - Fax:213-389-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty