Provider Demographics
NPI:1881851566
Name:KIM L COOPER MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KIM L COOPER MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:L
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-259-0300
Mailing Address - Street 1:1720 EL CAMINO REAL
Mailing Address - Street 2:SUITE 235
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3224
Mailing Address - Country:US
Mailing Address - Phone:650-259-0300
Mailing Address - Fax:650-259-0505
Practice Address - Street 1:1720 EL CAMINO REAL
Practice Address - Street 2:SUITE 235
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3224
Practice Address - Country:US
Practice Address - Phone:650-259-0300
Practice Address - Fax:650-259-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABF810ZMedicare PIN
CA00A492410Medicare PIN
CAF90713Medicare UPIN