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General NPI Number Information
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NPI Number | 1396969853
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Entity Type | Organization
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Legal Business Name | SOO JIN CHA O.D., INC
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 N BEACH BLVD
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City | LA HABRA
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State | CA
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Zip | 90631-4468
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Country | US
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Telephone | 562-697-7365
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Fax |
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Provider Business Mailing Address
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Address Line | 1841 W FALMOUTH AVE
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City | ANAHEIM
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State | CA
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Zip | 92801-7714
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SOO JIN CHA
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Credential | O.D.
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Telephone | 714-213-6153
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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 | 11412T
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License Number State | CA
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