Healthcare Provider Details

I. General information

NPI: 1396669644
Provider Name (Legal Business Name): KYJ OPTOMETRY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3858 W CARSON ST STE 110
TORRANCE CA
90503-6705
US

IV. Provider business mailing address

3858 W CARSON ST STE 110
TORRANCE CA
90503-6705
US

V. Phone/Fax

Practice location:
  • Phone: 310-792-6200
  • Fax:
Mailing address:
  • Phone: 310-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: KATIE JANG
Title or Position: CEO
Credential: OD
Phone: 310-408-2692