MEDICARE: JAMES PAUL 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	0618002066	VA

General Provider Information

NPI Number	:	1821373473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES PAUL KIM O.D.

Provider Business Mailing Address
First Line	:	8350 TRAFORD LN
Second Line	:	2ND FLOOR
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1664
Country	:	US
Telephone Number	:	703-569-6363
Fax Number	:	703-569-6363

Provider Business Practice Location Address
First Line	:	8350 TRAFORD LN
Second Line	:	2ND FLOOR
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1664
Country	:	US
Telephone Number	:	703-569-6363
Fax Number	:	703-569-6363

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

Provider Enumeration Date	:	10/14/2011
Last Update Date	:	10/14/2011

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