Organization
SOO YOUN KIM OD INC
Active
Parent organization
ZZZ25706Z
Other names
Fashion Eyes Optometry
Organization subpart
Yes
Provider details
NPI number
Legal business name
ZZZ25706Z
Authorized official
SOO YOUN KIM O.D (OWNER)
(909) 628-0300
Entity
Organization
Contact information
Practice address
14147 PIPELINE AVE, CHINO, CA 91710-5618
(909) 628-0300
Mailing address
14147 PIPELINE AVE, CHINO, CA 91710-5618
(909) 628-0300
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
OPT10349TPA
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0125235
—
CA
Enumeration date
12/14/2007
Last updated
01/23/2009
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