Provider Demographics
NPI:1538906912
Name:KIM, BECKY MIHAE
Entity type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:MIHAE
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3557 BRADSHAW RD STE 2E
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-3373
Mailing Address - Country:US
Mailing Address - Phone:916-508-2848
Mailing Address - Fax:
Practice Address - Street 1:3557 BRADSHAW RD STE 2E
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3373
Practice Address - Country:US
Practice Address - Phone:916-361-2020
Practice Address - Fax:916-361-0433
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10618T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist