Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 9722T | CA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 9722T | CA |
N | 152WV0400X | Optomitrist - Vision Therapist | 9722T | CA |
NPI | 1033257894 |
---|---|
Provider Name | Irene Iikyung Yim |
First Address | Rowland Heights, CA 91748-2762 |
Second Address | Rowland Heights, CA 91748-2762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 04/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SD0097220 | (05) | CA |