Provider Demographics
NPI:1619947181
Name:KOOK, LORIE JIHAE (OD)
Entity Type:Individual
Prefix:DR
First Name:LORIE
Middle Name:JIHAE
Last Name:KOOK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JI
Other - Middle Name:HAE
Other - Last Name:KOOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:16444 PARAMOUNT BLVD
Mailing Address - Street 2:STE 206
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5422
Mailing Address - Country:US
Mailing Address - Phone:323-732-8111
Mailing Address - Fax:323-638-2934
Practice Address - Street 1:16444 PARAMOUNT BLVD
Practice Address - Street 2:STE 206
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5422
Practice Address - Country:US
Practice Address - Phone:323-732-8111
Practice Address - Fax:323-638-2934
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 11071T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD110710Medicaid
CASD110710Medicaid
CAU79494Medicare UPIN