Provider Demographics
NPI:1659618031
Name:KIM, SARAH YOUNG (OD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:YOUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:YOUNG
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4027 MACPHEADRIS WAY
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7541
Mailing Address - Country:US
Mailing Address - Phone:213-448-1454
Mailing Address - Fax:916-487-2603
Practice Address - Street 1:4027 MACPHEADRIS WAY
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-7541
Practice Address - Country:US
Practice Address - Phone:213-448-1454
Practice Address - Fax:916-487-2603
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-06
Last Update Date:2013-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11276152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist