MEDICARE: DR. MICHELL 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	34920TLG	CA

General Provider Information

NPI Number	:	1285207985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELL KIM OD

Provider Business Mailing Address
First Line	:	17510 LA BONITA WAY
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-9039
Country	:	US
Telephone Number	:	714-675-3667
Fax Number	:

Provider Business Practice Location Address
First Line	:	2935 CHINO AVE STE E3
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-3575
Country	:	US
Telephone Number	:	909-627-1111
Fax Number	:	909-627-1112

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

Provider Enumeration Date	:	07/20/2021
Last Update Date	:	03/20/2025

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