Provider Demographics
NPI:1629097290
Name:KIM, JEAN HOJIN (OD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:HOJIN
Last Name:KIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9816 GARDEN GROVE BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1617
Mailing Address - Country:US
Mailing Address - Phone:714-539-2020
Mailing Address - Fax:714-539-2030
Practice Address - Street 1:9618 GARDEN GROVE BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1563
Practice Address - Country:US
Practice Address - Phone:714-539-2020
Practice Address - Fax:714-539-2030
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAOPT8760152W00000X, 152WC0802X, 152WP0200X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP8760BMedicare ID - Type Unspecified