Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 35038852K | OH |
NPI | 1003870643 |
---|---|
Provider Name | Grace Za Kim |
First Address | Columbus, OH 43213-4400 |
Second Address | Columbus, OH 43213-4400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 13/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0333099 | (05) | OH |
C01465 | (02) |