Individual
TIFFANY KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
10480 SW EASTRIDGE ST APT 37, PORTLAND, OR 97225-5042
(408) 805-0354
Mailing address
25699 SW ARGYLE AVE A, LENZA EYE CENTER, WILSONVILLE, OR 97070-5798
(503) 833-2662
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3607ATI
OR
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
10/10/2012
Last updated
09/23/2015
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