Individual
GRACE KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11540 SANTA MONICA BLVD STE 202, LOS ANGELES, CA 90025-7905
(310) 473-5464
Mailing address
11540 SANTA MONICA BLVD STE 202, LOS ANGELES, CA 90025-7905
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
35031TLG
CA
Other
Enumeration date
04/01/2021
Last updated
04/24/2023
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