Provider Demographics
NPI:1952783482
Name:KIM, CRYSTAL MINHEE (OD)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MINHEE
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 1:4247 S MOONEY BLVD
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-9146
Mailing Address - Country:US
Mailing Address - Phone:559-749-0751
Mailing Address - Fax:559-735-9786
Practice Address - Street 1:4247 S MOONEY BLVD
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-9146
Practice Address - Country:US
Practice Address - Phone:599-749-0751
Practice Address - Fax:599-735-9786
Is Sole Proprietor?:No
Enumeration Date:2015-06-20
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60644887152W00000X
CA15280152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist