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General NPI Number Information
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NPI Number | 1427016120
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Entity Type | Organization
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Legal Business Name | EYECARE MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 5832 BEACH BLVD UNIT 109
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City | BUENA PARK
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State | CA
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Zip | 90621-5500
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Country | US
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Telephone | 714-228-1888
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Fax | 714-676-8308
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Provider Business Mailing Address
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Address Line | PO BOX 190
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City | BUENA PARK
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State | CA
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Zip | 90621-0190
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Country | US
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Telephone | 714-228-1888
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Fax | 714-228-1888
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Authorized Official
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Title or Position | CEO
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Name | DR. YUN JIN KIM
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Credential | MD
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Telephone | 714-228-1888
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A60445
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License Number State | CA
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