Provider Demographics
NPI:1487707667
Name:GRIFFIN & REED A MEDICAL CORPORATION
Entity type:Organization
Organization Name:GRIFFIN & REED A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KWANG
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-483-2525
Mailing Address - Street 1:651 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4813
Mailing Address - Country:US
Mailing Address - Phone:916-483-2525
Mailing Address - Fax:
Practice Address - Street 1:651 FULTON AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4813
Practice Address - Country:US
Practice Address - Phone:916-483-2525
Practice Address - Fax:916-483-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12003T152WC0802X
CAA068743261QS0132X
CAG53735261QS0132X
CAA91190261QS0132X
CA7526T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CD6373OtherRAILROAD MEDICARE
CA0409800001Medicare NSC
CD6373OtherRAILROAD MEDICARE