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General NPI Number Information
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NPI Number | 1336486729
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Entity Type | Organization
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Legal Business Name | WALTER YIM OD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/07/2013
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Last Update Date | 03/18/2014
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Provider Practice Location Address
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Address Line | 16450 BOLSA CHICA ST
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-2603
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Country | US
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Telephone | 714-840-1366
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Fax | 714-846-9415
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Provider Business Mailing Address
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Address Line | 16450 BOLSA CHICA ST
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-2603
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Country | US
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Telephone | 714-840-1366
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Fax | 714-846-9415
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Authorized Official
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Title or Position | CEO
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Name | DR. WALTER YIM
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Credential | O.D.
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Telephone | 714-840-1366
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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 | 12675 TLG
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License Number State | CA
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