Provider Demographics
NPI:1265402788
Name:DOAN, KIM T (MD)
Entity type:Individual
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First Name:KIM
Middle Name:T
Last Name:DOAN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:19582 BEACH BLVD
Mailing Address - Street 2:#102
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2996
Mailing Address - Country:US
Mailing Address - Phone:714-965-0300
Mailing Address - Fax:714-963-1905
Practice Address - Street 1:19582 BEACH BLVD
Practice Address - Street 2:#102
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2996
Practice Address - Country:US
Practice Address - Phone:714-965-0300
Practice Address - Fax:714-963-1905
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAA74216207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI33674Medicare UPIN