=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154440204
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRILLIANT EYE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 06/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 270 LAGUNA RD SUITE 100
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92835-2521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-525-2375
-----------------------------------------------------
Fax | 714-871-9280
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 270 LAGUNA RD SUITE 100
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92835-2521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-525-2375
-----------------------------------------------------
Fax | 714-871-9280
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. MATTHEW H KIM
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 714-525-2375
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------