MEDICARE: DR. MICHELLE 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	11566	CA

General Provider Information

NPI Number	:	1457328825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE KIM OD

Provider Business Mailing Address
First Line	:	2027 SAN ELIJO AVE STE 2027
Second Line	:
City	:	CARDIFF
State	:	CA
Zip	:	92007-1726
Country	:	US
Telephone Number	:	760-452-2895
Fax Number	:	760-452-2898

Provider Business Practice Location Address
First Line	:	2027 SAN ELIJO AVE STE 2027
Second Line	:
City	:	CARDIFF
State	:	CA
Zip	:	92007-1726
Country	:	US
Telephone Number	:	760-452-2895
Fax Number	:	760-452-2898

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

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	03/25/2014

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