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General NPI Number Information
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NPI Number | 1114802659
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Entity Type | Individual
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Provider Name | YOUNG S KIM
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Gender | Male
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 4619 CONVOY ST # A6
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City | SAN DIEGO
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State | CA
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Zip | 92111-2318
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Country | US
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Telephone | 858-880-8945
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Fax |
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Provider Business Mailing Address
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Address Line | 4619 CONVOY ST # A6
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City | SAN DIEGO
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State | CA
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Zip | 92111-2318
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Country | US
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Telephone | 858-880-8945
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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 | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | RDO70566
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License Number State | CA
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