Provider Demographics
NPI:1417117227
Name:KIM, CHRISTA YONG EUN (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:YONG EUN
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 1:2339 ROUND MOUNTAIN CIR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5633
Mailing Address - Country:US
Mailing Address - Phone:847-922-3281
Mailing Address - Fax:972-899-3206
Practice Address - Street 1:2339 ROUND MOUNTAIN CIR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-5633
Practice Address - Country:US
Practice Address - Phone:847-922-3281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-15
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6015 T152W00000X
TX6015TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management