Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 136906 | CA |
NPI | 1003101874 |
---|---|
Provider Name | Grace L. Kim |
First Address | Irvine, CA 92697-4375 |
Second Address | Irvine, CA 92697-4375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2011 |
Last Update Date | 15/12/2021 |