Provider Demographics
NPI:1629051750
Name:AU, NATHAN HUNG (OD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:HUNG
Last Name:AU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2396 CRENSHAW BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3336
Mailing Address - Country:US
Mailing Address - Phone:310-320-0081
Mailing Address - Fax:310-320-0082
Practice Address - Street 1:2396 CRENSHAW BLVD STE C
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3336
Practice Address - Country:US
Practice Address - Phone:310-320-0081
Practice Address - Fax:310-320-0082
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA11857TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2349441Medicaid
CASO0011857Medicaid
CAWOP11857AMedicare PIN