MEDICARE: DEBORAH KIM O.D.

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	TBD	CA

General Provider Information

NPI Number	:	1750955704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH KIM O.D.

Provider Business Mailing Address
First Line	:	432 N CITRUS HILL LN
Second Line	:
City	:	LA HABRA
State	:	CA
Zip	:	90631-4570
Country	:	US
Telephone Number	:	818-304-1235
Fax Number	:

Provider Business Practice Location Address
First Line	:	432 N CITRUS HILL LN
Second Line	:
City	:	LA HABRA
State	:	CA
Zip	:	90631-4570
Country	:	US
Telephone Number	:	818-304-1235
Fax Number	:

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

Provider Enumeration Date	:	05/14/2021
Last Update Date	:	11/21/2022

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