MEDICARE: CATHERINE KIM O.D.

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	14397	CA

General Provider Information

NPI Number	:	1720333693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE KIM O.D.

Provider Business Mailing Address
First Line	:	453 IVY ST
Second Line	:	APT. 5
City	:	GLENDALE
State	:	CA
Zip	:	91204-1279
Country	:	US
Telephone Number	:	818-321-6594
Fax Number	:

Provider Business Practice Location Address
First Line	:	7217 RESEDA BLVD
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-3046
Country	:	US
Telephone Number	:	818-345-2010
Fax Number	:	818-345-2070

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

Provider Enumeration Date	:	07/17/2012
Last Update Date	:	07/17/2012

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