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General NPI Number Information
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NPI Number | 1063537397
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Entity Type | Individual
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Provider Name | AGNES (YANG EUN) PYONG KIM O.D.
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1021 ARNOLD DR LOCATED INSIDE WAL-MART
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City | MARTINEZ
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State | CA
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Zip | 94553-4103
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Country | US
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Telephone | 925-957-9378
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Fax | 925-957-9417
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Provider Business Mailing Address
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Address Line | 6084 RALSTON AVE
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City | RICHMOND
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State | CA
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Zip | 94805-1202
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Country | US
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Telephone | 510-215-2329
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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 | 12313T
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License Number State | CA
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