Provider Demographics
NPI:1588615926
Name:KIM, ANNY PAEK (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNY
Middle Name:PAEK
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 1:169 CHRISTIANA RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-3040
Mailing Address - Country:US
Mailing Address - Phone:302-322-4444
Mailing Address - Fax:302-322-0875
Practice Address - Street 1:169 CHRISTIANA RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-3040
Practice Address - Country:US
Practice Address - Phone:302-322-4444
Practice Address - Fax:302-322-0875
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001587152W00000X
NJ27TO00128300152W00000X
NYTUV0065431152W00000X
DE130001296152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DECB4722OtherRAILROAD MEDICARE PIN
DE410033511OtherRAILROAD MEDICARE ALTERNATE PIN
DEU92405Medicare UPIN
DECB4722OtherRAILROAD MEDICARE PIN
DE017867D95Medicare PIN