Healthcare Provider Details

I. General information

NPI: 1801726369
Provider Name (Legal Business Name): DR. KIM OPTOMETRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2443 FOOTHILL BLVD
LA VERNE CA
91750-3028
US

IV. Provider business mailing address

2443 FOOTHILL BLVD
LA VERNE CA
91750-3028
US

V. Phone/Fax

Practice location:
  • Phone: 714-307-1764
  • Fax:
Mailing address:
  • Phone: 714-307-1764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JOANNE J KIM
Title or Position: DOCTOR
Credential: OD
Phone: 714-307-1764