=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497807838
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANETTE J KIM O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 317 N LARCHMONT BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90004-3011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-465-9682
-----------------------------------------------------
Fax | 323-467-4043
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18527 CALLE VISTA CIR
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91326-1927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-368-0192
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 12815
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------