1053343137 NPI number — GREGORY Y. KAME, O.D., F.A.A.O., A PROFESSIONAL CORPORATION

Table of content: (NPI 1053343137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053343137 NPI number — GREGORY Y. KAME, O.D., F.A.A.O., A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREGORY Y. KAME, O.D., F.A.A.O., A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LOS ANGELES EYECARE OPTOMETRY GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053343137
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
334B E 2ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90012-4203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-628-7419
Provider Business Mailing Address Fax Number:
213-620-9110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
334B E 2ND ST STE 802
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90012-4203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-628-7419
Provider Business Practice Location Address Fax Number:
213-620-9110
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KAME
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
YUJI
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
213-628-7419

Provider Taxonomy Codes

  • Taxonomy code: 152WC0802X , with the licence number:  11157T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DP3156 . This is a "PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: WY7779 . This is a "PTIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com