Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 10123T | CA |
NPI | 1003029505 |
---|---|
Provider Name | Dr. Eunmi Chae |
First Address | Van Nuys, CA 91406-3510 |
Second Address | Van Nuys, CA 91406-3510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 30/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003029505 | (05) | CA |