Provider Demographics
NPI:1891812855
Name:KIM, YON SU (OD)
Entity Type:Individual
Prefix:DR
First Name:YON
Middle Name:SU
Last Name:KIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10809 IVORYTON WAY
Mailing Address - Street 2:
Mailing Address - City:MATHER
Mailing Address - State:CA
Mailing Address - Zip Code:95655-3045
Mailing Address - Country:US
Mailing Address - Phone:916-361-8211
Mailing Address - Fax:
Practice Address - Street 1:10655 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-4828
Practice Address - Country:US
Practice Address - Phone:916-369-1140
Practice Address - Fax:916-369-1148
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12449T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist