Healthcare Provider Details

I. General information

NPI: 1487707667
Provider Name (Legal Business Name): GRIFFIN & REED A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 FULTON AVE
SACRAMENTO CA
95825-4813
US

IV. Provider business mailing address

651 FULTON AVE
SACRAMENTO CA
95825-4813
US

V. Phone/Fax

Practice location:
  • Phone: 916-483-2525
  • Fax: 916-483-2636
Mailing address:
  • Phone: 916-483-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License NumberA068743
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License NumberG53735
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License NumberA91190
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number12003T
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number7526T
License Number StateCA

VIII. Authorized Official

Name: DR. KWANG S KIM
Title or Position: OWNER PRESIDENT
Credential: M.D.
Phone: 916-483-2525