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General NPI Number Information
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NPI Number | 1942352349
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Entity Type | Individual
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Provider Name | SUSAN CHAO KIM O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 44414 VALLEY CENTRAL WAY VALLEY CENTRAL SHOPPING CENTER
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City | LANCASTER
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State | CA
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Zip | 93536-6528
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Country | US
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Telephone | 661-723-5381
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Fax | 661-723-1335
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Provider Business Mailing Address
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Address Line | 44414 VALLEY CENTRAL WAY VALLEY CENTRAL SHOPPING CENTER
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City | LANCASTER
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State | CA
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Zip | 93536-6528
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Country | US
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Telephone | 661-723-5381
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Fax | 661-723-1335
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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 | 9220T
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License Number State | CA
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