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General NPI Number Information
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NPI Number | 1043343833
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Entity Type | Organization
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Legal Business Name | MIAE C. KIM, O.D., OPTOMETRIC COPORATION
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 04/22/2013
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Provider Practice Location Address
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Address Line | 1296 KIFER RD SUITE 602
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City | SUNNYVALE
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State | CA
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Zip | 94086-5318
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Country | US
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Telephone | 408-737-2020
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Fax | 408-716-2439
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Provider Business Mailing Address
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Address Line | 1296 KIFER RD SUITE 602
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City | SUNNYVALE
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State | CA
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Zip | 94086-5318
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Country | US
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Telephone | 408-737-2020
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Fax | 408-716-2439
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. MIAE C KIM
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Credential | O.D.
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Telephone | 408-737-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 12312
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License Number State | CA
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