1952732679 NPI number — YOUNG S. KIM OPTOMETRIC CENTER INC.

Table of content: (NPI 1952732679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952732679 NPI number — YOUNG S. KIM OPTOMETRIC CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUNG S. KIM OPTOMETRIC CENTER INC.
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:
ILA OPTOMETRY
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:
1952732679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3183 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
#115
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90010-1211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-738-0007
Provider Business Mailing Address Fax Number:
213-738-0033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3183 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
#115
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90010-1211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-738-0007
Provider Business Practice Location Address Fax Number:
213-738-0033
Provider Enumeration Date:
12/05/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
YOUNG
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
213-738-0007

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  10134T , 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: SD0101340 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".