Provider Demographics
NPI:1598892630
Name:KOSTURA, SONIA KIM (OD)
Entity Type:Individual
Prefix:DR
First Name:SONIA
Middle Name:KIM
Last Name:KOSTURA
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 1:21612 PLANO TRABUCO RD STE C
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-3488
Mailing Address - Country:US
Mailing Address - Phone:949-459-5687
Mailing Address - Fax:949-459-5690
Practice Address - Street 1:21612 PLANO TRABUCO RD STE C
Practice Address - Street 2:
Practice Address - City:TRABUCO CANYON
Practice Address - State:CA
Practice Address - Zip Code:92679-3488
Practice Address - Country:US
Practice Address - Phone:949-459-5687
Practice Address - Fax:949-459-5690
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12317T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist