=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922164433
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCULAR INSTITUTE OF CALIFORNIA, A MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2006
-----------------------------------------------------
Last Update Date | 02/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9428 VALLEY BLVD. STE 201
-----------------------------------------------------
City | ROSEMEAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91770-1514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-350-6776
-----------------------------------------------------
Fax | 626-350-3353
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 708
-----------------------------------------------------
City | ROSEMEAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91770-0708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-485-4007
-----------------------------------------------------
Fax | 626-226-4024
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STEVEN SHUOH-TYNG MA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 626-485-4007
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | A62421
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------