Provider Demographics
NPI:1891874574
Name:KIM, JANE (OD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2752
Mailing Address - Country:US
Mailing Address - Phone:626-696-3607
Mailing Address - Fax:626-696-3608
Practice Address - Street 1:1741 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2752
Practice Address - Country:US
Practice Address - Phone:626-696-3607
Practice Address - Fax:626-696-3608
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13140152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist