MEDICARE: DR. HEEJUNG KOH OPTOMETRIC CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	12818	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689861353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. HEEJUNG KOH OPTOMETRIC CORPORATION

Provider Business Mailing Address
First Line	:	18337 COLIMA RD
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2762
Country	:	US
Telephone Number	:	626-854-1131
Fax Number	:

Provider Business Practice Location Address
First Line	:	18337 COLIMA RD
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2762
Country	:	US
Telephone Number	:	626-854-1131
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HEEJUNG KOH
Credential	:	O.D.
Telephone Number	:	626-854-1131

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	01/30/2008

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