Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | SL40534 | CA |
NPI | 1194171363 |
---|---|
Provider Name | Haiming Yu |
First Address | Pasadena, CA 91107-4263 |
Second Address | Pasadena, CA 91107-4263 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2016 |
Last Update Date | 06/05/2016 |