Provider Demographics
NPI:1598852816
Name:KIM, PAUL H (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1400 W 6TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-6508
Mailing Address - Country:US
Mailing Address - Phone:951-734-2001
Mailing Address - Fax:951-734-2323
Practice Address - Street 1:1400 W 6TH ST STE 101
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-6508
Practice Address - Country:US
Practice Address - Phone:951-734-2001
Practice Address - Fax:951-734-2323
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11030T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist