Provider Demographics
NPI:1457401259
Name:KIM, EVA C (MD)
Entity type:Individual
Prefix:DR
First Name:EVA
Middle Name:C
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 E MEXICO AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3941
Mailing Address - Country:US
Mailing Address - Phone:720-524-1001
Mailing Address - Fax:720-524-1121
Practice Address - Street 1:3900 E MEXICO AVE STE 102
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3941
Practice Address - Country:US
Practice Address - Phone:720-524-1001
Practice Address - Fax:720-524-1121
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90446207W00000X
CODR.0057104207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO027494OtherKAISER COMMERCIAL NUMBER
CO18315526Medicaid
CO534589YK5YMedicare PIN
I30216Medicare UPIN