Provider Demographics
NPI:1558524462
Name:KIM, JULIA E (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:E
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 1:171 ROOSEVELT PLACE
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650
Mailing Address - Country:US
Mailing Address - Phone:917-715-5600
Mailing Address - Fax:
Practice Address - Street 1:171 ROOSEVELT PLACE
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650
Practice Address - Country:US
Practice Address - Phone:917-715-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007281-1152W00000X
NJ27OA00615500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist