Basic Information
| Provider Information | |||||||||
| NPI: | 1861516478 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | HENRI | ||||||||
| MiddleName: | DONG-HA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34 MANOR DR | ||||||||
| Address2: | |||||||||
| City: | PIEDMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946114144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104353462 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1919 DAVIS ST | ||||||||
| Address2: | |||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945771208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104309908 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 04/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 11903TLG | CA | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | 11903T | CA | N | Eye and Vision Services Providers | Optometrist |
No ID Information.