Healthcare Provider Details

I. General information

NPI: 1629272893
Provider Name (Legal Business Name): YIM & KOOK PROFESSIONAL OPTOMETRIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18337 COLIMA RD
ROWLAND HEIGHTS CA
91748-2762
US

IV. Provider business mailing address

18337 COLIMA RD
ROWLAND HEIGHTS CA
91748-2762
US

V. Phone/Fax

Practice location:
  • Phone: 626-854-1131
  • Fax: 626-854-1727
Mailing address:
  • Phone: 626-854-1131
  • Fax: 626-854-1727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number9722
License Number StateCA

VIII. Authorized Official

Name: DR. IRENE INKYUNG YIM
Title or Position: PRESIDENT
Credential: O.D.
Phone: 626-854-1131