MEDICARE: DR. SUNG MI YOM O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4663	MA
2	152W00000X	Optometrist	13613T	CA

General Provider Information

NPI Number	:	1316106339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUNG MI YOM O.D.

Provider Business Mailing Address
First Line	:	3240 WILSHIRE BLVD STE 112A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1502
Country	:	US
Telephone Number	:	847-372-4527
Fax Number	:	213-427-3537

Provider Business Practice Location Address
First Line	:	3240 WILSHIRE BLVD STE 112A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1502
Country	:	US
Telephone Number	:	847-372-4527
Fax Number	:	213-427-3537

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	10/25/2024

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