Provider Demographics
NPI:1750555934
Name:HONG K KU OD INC
Entity type:Organization
Organization Name:HONG K KU OD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HONG
Authorized Official - Middle Name:KANG
Authorized Official - Last Name:KU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-830-2201
Mailing Address - Street 1:22215 AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-3359
Mailing Address - Country:US
Mailing Address - Phone:310-830-2201
Mailing Address - Fax:310-830-2241
Practice Address - Street 1:22215 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-3359
Practice Address - Country:US
Practice Address - Phone:310-830-2201
Practice Address - Fax:310-830-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12786T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FA233AMedicare PIN