MEDICARE: KATIE Y JANG OPTOMETRY PROFESSIONAL CORPORATION

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

General Provider Information

NPI Number	:	1881388650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATIE Y JANG OPTOMETRY PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	35 LINDEN AVE STE 102
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-5033
Country	:	US
Telephone Number	:	562-435-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 LINDEN AVE STE 102
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-5033
Country	:	US
Telephone Number	:	562-435-2020
Fax Number	:

Authorized Official
Title or Position	:	OD
Name	:	KATIE JANG
Credential	:
Telephone Number	:	310-408-2692

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	09/01/2023

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