MEDICARE: DR. JANE 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	13140	CA

General Provider Information

NPI Number	:	1891874574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANE KIM O.D.

Provider Business Mailing Address
First Line	:	1741 E WASHINGTON BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-2752
Country	:	US
Telephone Number	:	626-696-3607
Fax Number	:	626-696-3608

Provider Business Practice Location Address
First Line	:	1741 E WASHINGTON BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-2752
Country	:	US
Telephone Number	:	626-696-3607
Fax Number	:	626-696-3608

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	11/08/2011

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