Organization
CERRITOS EYE MEDICAL CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAE SUN KIM M.D. (OWNER/PRESIDENT)
(562) 402-4720
Entity
Organization
Contact information
Practice address
11829 SOUTH ST, SUITE 202, CERRITOS, CA 90703-6828
(562) 402-4720
(562) 402-9231
Mailing address
11829 SOUTH ST, SUITE 202, CERRITOS, CA 90703-6828
(562) 402-4720
(562) 402-9231
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
A87753
CA
207W00000X
Ophthalmology Physician
Primary
G96402
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A877530
—
CA
05
—
GR0091370
—
CA
01
—
WA87753C
MEDICARE PTAN
CA
Enumeration date
06/26/2006
Last updated
11/15/2007
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