Healthcare Provider Details

I. General information

NPI: 1326967183
Provider Name (Legal Business Name): DR. KIM OPTOMETRY UPLAND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1637 N MOUNTAIN AVE
UPLAND CA
91784-1732
US

IV. Provider business mailing address

1637 N MOUNTAIN AVE
UPLAND CA
91784-1732
US

V. Phone/Fax

Practice location:
  • Phone: 909-982-0100
  • Fax: 909-593-0786
Mailing address:
  • Phone: 909-982-0100
  • Fax: 909-593-0786

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: CEO
Credential: OD
Phone: 909-982-0100