Provider Demographics
NPI:1679962179
Name:JOANNE J. KIM OD INC
Entity type:Organization
Organization Name:JOANNE J. KIM OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OD
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:JI YUN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-628-0300
Mailing Address - Street 1:14147 PIPELINE AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5618
Mailing Address - Country:US
Mailing Address - Phone:909-628-0300
Mailing Address - Fax:
Practice Address - Street 1:14147 PIPELINE AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5618
Practice Address - Country:US
Practice Address - Phone:909-628-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13418152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty