Provider Demographics
NPI:1063537397
Name:KIM, AGNES (YANG EUN) PYONG (OD)
Entity type:Individual
Prefix:
First Name:AGNES (YANG EUN)
Middle Name:PYONG
Last Name:KIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:YANG EUN
Other - Middle Name:PYONG
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:6084 RALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-1202
Mailing Address - Country:US
Mailing Address - Phone:510-215-2329
Mailing Address - Fax:
Practice Address - Street 1:1021 ARNOLD DR
Practice Address - Street 2:LOCATED INSIDE WAL-MART
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4103
Practice Address - Country:US
Practice Address - Phone:925-957-9378
Practice Address - Fax:925-957-9417
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12313T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist