Provider Demographics
NPI:1780709329
Name:KIM, ESTHER OHN (OD)
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:OHN
Last Name:KIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:SUNG-HEE
Other - Last Name:OHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:214 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-3201
Mailing Address - Country:US
Mailing Address - Phone:408-293-3730
Mailing Address - Fax:408-293-2131
Practice Address - Street 1:214 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-3201
Practice Address - Country:US
Practice Address - Phone:408-293-3730
Practice Address - Fax:408-293-2131
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12518TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV08383Medicare UPIN