Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | CA |
NPI | 1023221371 |
---|---|
Provider Name | Mr. Ung Soo Kim |
First Address | Los Angeles, CA 90006-2484 |
Second Address | Los Angeles, CA 90006-2484 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 08/07/2007 |