Healthcare Provider Details

I. General information

NPI: 1235102559
Provider Name (Legal Business Name): YOON KIM OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 NJ-15 SOUTH
LAKE HOPATCONG NJ
07849
US

IV. Provider business mailing address

4 2ND AVE SUITE 104
DENVILLE NJ
07834
US

V. Phone/Fax

Practice location:
  • Phone: 973-663-0800
  • Fax: 973-663-0103
Mailing address:
  • Phone: 973-627-8818
  • Fax: 973-327-7274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV0059361
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: