1962591396 NPI number — DR. KATHY KIM O.D.

Table of content: DR. KATHY KIM O.D. (NPI 1962591396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962591396 NPI number — DR. KATHY KIM O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
KATHY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962591396
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8520 STEILACOOM BLVD SW STE 200A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98498-4773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-475-3937
Provider Business Mailing Address Fax Number:
253-201-2348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8520 STEILACOOM BLVD SW STE 200A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98498-4773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-475-3937
Provider Business Practice Location Address Fax Number:
253-201-2348
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3950 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 050612108 . This is a "PREMERA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 050612108 . This is a "TRICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2030831 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050612108 . This is a "FIRST CHOICE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 050612108 . This is a "UNIFORM" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5814065 . This is a "CIGNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: #KIM . This is a "MARCH VISION CARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: REGENCE . This is a "9659KI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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