Provider Demographics
NPI:1841314408
Name:KIM, PAUL K (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:K
Last Name:KIM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3557 BRADSHAW RD
Mailing Address - Street 2:STE 2E
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-3373
Mailing Address - Country:US
Mailing Address - Phone:916-361-2020
Mailing Address - Fax:916-361-0433
Practice Address - Street 1:3557 BRADSHAW ROAD #2E
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3373
Practice Address - Country:US
Practice Address - Phone:916-361-2020
Practice Address - Fax:916-361-0433
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 10618 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGI449AMedicare PIN