Provider Demographics
NPI:1538455803
Name:KIM, JAMES CHANG HO (OD, FAAO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CHANG HO
Last Name:KIM
Suffix:
Gender:M
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 GRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-1204
Mailing Address - Country:US
Mailing Address - Phone:718-388-8409
Mailing Address - Fax:718-388-8267
Practice Address - Street 1:240 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-1204
Practice Address - Country:US
Practice Address - Phone:718-388-8409
Practice Address - Fax:718-388-8267
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007717152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist