Provider Demographics
NPI:1619003910
Name:KIM, SUSAN HYUN JOO (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:HYUN JOO
Last Name:KIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5980 STONERIDGE DR
Mailing Address - Street 2:STE 110
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2723
Mailing Address - Country:US
Mailing Address - Phone:925-463-7330
Mailing Address - Fax:925-463-7337
Practice Address - Street 1:5980 STONERIDGE DR
Practice Address - Street 2:STE 110
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2723
Practice Address - Country:US
Practice Address - Phone:925-463-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9880T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist