Provider Demographics
NPI:1972655371
Name:KIM, JULIE JUNG EUN (OD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:JUNG EUN
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 1:1319 HARBOR BLVD.
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-3001
Mailing Address - Country:US
Mailing Address - Phone:714-525-3330
Mailing Address - Fax:714-525-3334
Practice Address - Street 1:7960 ORANGETHORPE AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3437
Practice Address - Country:US
Practice Address - Phone:714-521-3002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12817152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist