Provider Demographics
NPI:1285315499
Name:JOLI OCULOPLASTICS, LLC
Entity type:Organization
Organization Name:JOLI OCULOPLASTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-484-4047
Mailing Address - Street 1:10710 MEDLOCK BRIDGE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2440
Mailing Address - Country:US
Mailing Address - Phone:770-629-0600
Mailing Address - Fax:770-215-7522
Practice Address - Street 1:10710 MEDLOCK BRIDGE RD STE 150
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-2440
Practice Address - Country:US
Practice Address - Phone:770-629-0600
Practice Address - Fax:770-215-7522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Single Specialty