Provider Demographics
NPI:1962591396
Name:KIM, KATHY (OD)
Entity type:Individual
Prefix:DR
First Name:KATHY
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 1:8520 STEILACOOM BLVD SW STE 200A
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-4773
Mailing Address - Country:US
Mailing Address - Phone:253-475-3937
Mailing Address - Fax:253-201-2348
Practice Address - Street 1:8520 STEILACOOM BLVD SW STE 200A
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-4773
Practice Address - Country:US
Practice Address - Phone:253-475-3937
Practice Address - Fax:253-201-2348
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3950152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA050612108OtherPREMERA
WA050612108OtherTRICARE
WA2030831Medicaid
WA050612108OtherFIRST CHOICE
WA050612108OtherUNIFORM
WA5814065OtherCIGNA
WA#KIMOtherMARCH VISION CARE
WAREGENCEOther9659KI
WA8855468Medicare PIN
WA#KIMOtherMARCH VISION CARE
WA050612108OtherFIRST CHOICE