Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 159463 | CA |
NPI | 1013452358 |
---|---|
Provider Name | Tai Ho Kim |
First Address | Los Angeles, CA 90020-5801 |
Second Address | Los Angeles, CA 90020-5801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2016 |
Last Update Date | 22/12/2016 |