Provider Demographics
NPI:1366411613
Name:KIM, JOYCE (OD)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 S. WOLFE RD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-8880
Mailing Address - Country:US
Mailing Address - Phone:408-737-7007
Mailing Address - Fax:
Practice Address - Street 1:1021 S. WOLFE RD
Practice Address - Street 2:SUITE 145
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-8880
Practice Address - Country:US
Practice Address - Phone:408-737-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7401152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0074010Medicaid
CASD0074010Medicaid