Healthcare Provider Details

I. General information

NPI: 1902161359
Provider Name (Legal Business Name): LINDA HYUN-BUM HUR O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 TARA HILLS DR SUITE D
PINOLE CA
94564-2530
US

IV. Provider business mailing address

1451 BAIGORRY ST
TRACY CA
95304-5906
US

V. Phone/Fax

Practice location:
  • Phone: 510-724-1768
  • Fax:
Mailing address:
  • Phone: 209-481-9344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: