1619947181 NPI number — DR. LORIE JIHAE KOOK O.D.

Table of content: DR. LORIE JIHAE KOOK O.D. (NPI 1619947181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619947181 NPI number — DR. LORIE JIHAE KOOK O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOOK
Provider First Name:
LORIE
Provider Middle Name:
JIHAE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOOK
Provider Other First Name:
JI
Provider Other Middle Name:
HAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619947181
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16444 PARAMOUNT BLVD
Provider Second Line Business Mailing Address:
STE 206
Provider Business Mailing Address City Name:
PARAMOUNT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90723-5422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-732-8111
Provider Business Mailing Address Fax Number:
323-638-2934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16444 PARAMOUNT BLVD
Provider Second Line Business Practice Location Address:
STE 206
Provider Business Practice Location Address City Name:
PARAMOUNT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90723-5422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-732-8111
Provider Business Practice Location Address Fax Number:
323-638-2934
Provider Enumeration Date:
01/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPT 11071T , 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: SD110710 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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