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General NPI Number Information
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NPI Number | 1376178327
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Entity Type | Individual
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Provider Name | CHRIS Y KIM DO
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Gender | Male
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Dates
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Enumeration Date | 03/10/2020
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 208 VINTAGE WAY STE K21
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City | NOVATO
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State | CA
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Zip | 94945-5016
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Country | US
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Telephone | 415-897-3377
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Fax | 415-897-5722
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Provider Business Mailing Address
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Address Line | 4756 WINDING CREEK AVE
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City | SANTA ROSA
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State | CA
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Zip | 95409-3436
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Country | US
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Telephone | 707-292-5652
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | SLD1717
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License Number State | CA
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