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General NPI Number Information
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NPI Number | 1750109567
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Entity Type | Organization
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Legal Business Name | PAUL KIM OPTOMETRY APPLE VALLEY A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 19071 BEAR VALLEY RD STE 3
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City | APPLE VALLEY
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State | CA
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Zip | 92308-2718
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Country | US
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Telephone | 760-452-3990
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Fax |
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Provider Business Mailing Address
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Address Line | 19071 BEAR VALLEY RD STE 3
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City | APPLE VALLEY
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State | CA
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Zip | 92308-2718
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Country | US
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Telephone | 760-452-3990
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL KIM
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Credential | OD
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Telephone | 630-903-8988
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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 |
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License Number State |
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