Provider Demographics
NPI:1386128528
Name:AMY KIM OPTOMETRY, INC.
Entity type:Organization
Organization Name:AMY KIM OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAE
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:IKEFUGI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-542-7070
Mailing Address - Street 1:21880 HAWTHORNE BLVD # 331A
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-7031
Mailing Address - Country:US
Mailing Address - Phone:310-542-7070
Mailing Address - Fax:310-542-5215
Practice Address - Street 1:21880 HAWTHORNE BLVD # 331A
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-7031
Practice Address - Country:US
Practice Address - Phone:310-542-7070
Practice Address - Fax:310-542-5215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty