Healthcare Provider Details

I. General information

NPI: 1497262141
Provider Name (Legal Business Name): KOHARAEYE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 HUGHES AVE STE 104
CULVER CITY CA
90232-6834
US

IV. Provider business mailing address

8605 SANTA MONICA BLVD # 69638
LOS ANGELES CA
90069-4109
US

V. Phone/Fax

Practice location:
  • Phone: 323-682-0289
  • Fax: 855-538-9401
Mailing address:
  • Phone: 323-682-0289
  • Fax: 855-538-9401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EUNICE MAYA KOHARA
Title or Position: PRESIDENT
Credential: DO
Phone: 323-682-0289