Provider Demographics
NPI:1902022924
Name:KIM, IN YUL (ABO, NCLE)
Entity Type:Individual
Prefix:MR
First Name:IN YUL
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:ABO, NCLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16300 CRENSHAW BL.
Mailing Address - Street 2:#105
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504
Mailing Address - Country:US
Mailing Address - Phone:310-538-3544
Mailing Address - Fax:
Practice Address - Street 1:16300 CRENSHAW BLVD
Practice Address - Street 2:#105
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-1439
Practice Address - Country:US
Practice Address - Phone:310-538-3544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA004398156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician