Healthcare Provider Details

I. General information

NPI: 1104932193
Provider Name (Legal Business Name): JAMES K YI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 12/08/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 COCHRAN ST
SIMI VALLEY CA
93065-2780
US

IV. Provider business mailing address

2812 COCHRAN ST
SIMI VALLEY CA
93065-2780
US

V. Phone/Fax

Practice location:
  • Phone: 805-527-6164
  • Fax: 805-527-4391
Mailing address:
  • Phone: 805-527-6164
  • Fax: 805-527-4391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: