Provider Demographics
NPI:1427100924
Name:KIM, EILEEN HEE-UN (OD)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:HEE-UN
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 1:2651 BLANDING AVE
Mailing Address - Street 2:STE B
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1580
Mailing Address - Country:US
Mailing Address - Phone:510-748-9749
Mailing Address - Fax:
Practice Address - Street 1:2651 BLANDING AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1580
Practice Address - Country:US
Practice Address - Phone:510-748-9749
Practice Address - Fax:510-748-9869
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11902T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU91942Medicare UPIN