# CERRITOS EYE MEDICAL CENTER, INC.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598792889
- **Authorized official:** DR. TAE SUN KIM M.D. (OWNER/PRESIDENT)
- **Authorized official phone:** (562) 402-4720

## Contact information

- **Practice address:** 11829 SOUTH ST, SUITE 202, CERRITOS, CA 90703-6828
- **Practice address phone:** (562) 402-4720
- **Practice address fax:** (562) 402-9231
- **Mailing address:** 11829 SOUTH ST, SUITE 202, CERRITOS, CA 90703-6828
- **Mailing address phone:** (562) 402-4720
- **Mailing address fax:** (562) 402-9231

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | A87753 | CA | — |
| 207W00000X | Ophthalmology Physician | G96402 | CA | Yes |

## Other

- **Enumeration date:** 06/26/2006
- **Last updated:** 11/15/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00A877530 | — | CA |
| 05 | — | GR0091370 | — | CA |
| 01 | — | WA87753C | MEDICARE PTAN | CA |