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General NPI Number Information
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NPI Number | 1861516478
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Entity Type | Individual
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Provider Name | HENRI DONG-HA KIM O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 04/01/2021
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Provider Practice Location Address
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Address Line | 1919 DAVIS ST
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City | SAN LEANDRO
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State | CA
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Zip | 94577-1208
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Country | US
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Telephone | 510-430-9908
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Fax |
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Provider Business Mailing Address
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Address Line | 34 MANOR DR
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City | PIEDMONT
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State | CA
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Zip | 94611-4144
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Country | US
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Telephone | 510-435-3462
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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 | 11903TLG
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11903T
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License Number State | CA
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