MEDICARE: DR. JEE Y KIM OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT 9019 TPA	CA

General Provider Information

NPI Number	:	1245423243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEE Y KIM OD

Provider Business Mailing Address
First Line	:	978 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-1611
Country	:	US
Telephone Number	:	213-736-0205
Fax Number	:	213-368-0504

Provider Business Practice Location Address
First Line	:	978 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-1611
Country	:	US
Telephone Number	:	213-736-0205
Fax Number	:	213-368-0504

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	08/22/2007

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