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General NPI Number Information
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NPI Number | 1295212587
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Entity Type | Organization
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Legal Business Name | KIMURA MCCLENAGHAN OPTOMETRICS, INC.
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Dates
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Enumeration Date | 07/19/2018
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 416 N FAIRFAX AVE
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City | LOS ANGELES
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State | CA
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Zip | 90036-1717
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Country | US
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Telephone | 323-424-7280
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Fax |
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Provider Business Mailing Address
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Address Line | 7062 HAWTHORN AVE APT 302
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City | LOS ANGELES
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State | CA
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Zip | 90028-7099
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Country | US
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Telephone | 310-430-0225
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OPTOMETRIST
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Name | DR. AYUMI ANGIE KIMURA
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Credential | O.D.
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Telephone | 310-430-0225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 13034T
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License Number State | CA
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