Provider Demographics
NPI:1497978357
Name:KIM, STANTON (OD,FOAA)
Entity Type:Individual
Prefix:DR
First Name:STANTON
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:OD,FOAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4706 BARRANCA PKWY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4730
Mailing Address - Country:US
Mailing Address - Phone:949-857-2020
Mailing Address - Fax:949-857-2027
Practice Address - Street 1:4706 BARRANCA PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4730
Practice Address - Country:US
Practice Address - Phone:949-857-2020
Practice Address - Fax:949-857-2027
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAT8761152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist