MEDICARE: BYUNG YOON 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	11029T	TX

General Provider Information

NPI Number	:	1588437628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BYUNG YOON KIM OD

Provider Business Mailing Address
First Line	:	8614 WESTWOOD CENTER DR FL 9
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-2442
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 W 7TH ST STE 132
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2311
Country	:	US
Telephone Number	:	817-420-7377
Fax Number	:

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

Provider Enumeration Date	:	10/31/2023
Last Update Date	:	11/08/2023

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Directions to “ BYUNG YOON KIM OD” Practice Location

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