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General NPI Number Information
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NPI Number | 1053274720
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Entity Type | Individual
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Provider Name | VIVIAN KIM
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Gender |
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 12182 1/2 VENTURA BLVD
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City | STUDIO CITY
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State | CA
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Zip | 91604-2517
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Country | US
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Telephone | 818-921-7335
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Fax |
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Provider Business Mailing Address
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Address Line | 5363 EDGEWOOD PL APT B
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City | LOS ANGELES
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State | CA
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Zip | 90019-6761
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPT36150-TLG
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License Number State | CA
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