Provider Demographics
NPI:1982019238
Name:YANG E KIM
Entity Type:Organization
Organization Name:YANG E KIM
Other - Org Name:CASTROVILLE OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDERICKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:831-633-2525
Mailing Address - Street 1:11280 MERRITT ST
Mailing Address - Street 2:A150
Mailing Address - City:CASTROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95012-3421
Mailing Address - Country:US
Mailing Address - Phone:831-633-2525
Mailing Address - Fax:
Practice Address - Street 1:11280 MERRITT ST
Practice Address - Street 2:A150
Practice Address - City:CASTROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95012-3421
Practice Address - Country:US
Practice Address - Phone:831-633-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12576152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty