Healthcare Provider Details

I. General information

NPI: 1336486729
Provider Name (Legal Business Name): WALTER YIM OD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16450 BOLSA CHICA ST
HUNTINGTON BEACH CA
92649-2603
US

IV. Provider business mailing address

16450 BOLSA CHICA ST
HUNTINGTON BEACH CA
92649-2603
US

V. Phone/Fax

Practice location:
  • Phone: 714-840-1366
  • Fax: 714-846-9415
Mailing address:
  • Phone: 714-840-1366
  • Fax: 714-846-9415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12675 TLG
License Number StateCA

VIII. Authorized Official

Name: DR. WALTER YIM
Title or Position: CEO
Credential: O.D.
Phone: 714-840-1366