MEDICARE: DARLENE KIM OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901005379	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346892361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARLENE KIM OD

Provider Business Mailing Address
First Line	:	735 JOHN R RD STE 150
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48083-5859
Country	:	US
Telephone Number	:	248-588-9300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1961 S TELEGRAPH RD STE 101
Second Line	:
City	:	BLOOMFIELD TOWNSHIP
State	:	MI
Zip	:	48302-0246
Country	:	US
Telephone Number	:	248-972-2555
Fax Number	:	248-972-2585

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2019
Last Update Date	:	10/27/2020

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Directions to “ DARLENE KIM OD” Practice Location

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