Provider Demographics
NPI:1558381905
Name:COOPER, KIM L (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:L
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1720 EL CAMINO REAL
Mailing Address - Street 2:SUITE 235
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3224
Mailing Address - Country:US
Mailing Address - Phone:650-259-0300
Mailing Address - Fax:650-259-0300
Practice Address - Street 1:1720 EL CAMINO REAL
Practice Address - Street 2:SUITE 235
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3224
Practice Address - Country:US
Practice Address - Phone:650-259-0300
Practice Address - Fax:650-259-0505
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2016-05-03
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Provider Licenses
StateLicense IDTaxonomies
CAA049241207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF90713Medicare UPIN
CA00A492410Medicare ID - Type Unspecified