Provider Demographics
NPI:1720333693
Name:KIM, CATHERINE (OD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
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 1:453 IVY ST
Mailing Address - Street 2:APT. 5
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1279
Mailing Address - Country:US
Mailing Address - Phone:818-321-6594
Mailing Address - Fax:
Practice Address - Street 1:7217 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-3046
Practice Address - Country:US
Practice Address - Phone:818-345-2010
Practice Address - Fax:818-345-2070
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14397152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist