Provider Demographics
NPI:1912927419
Name:KOOK, EMILY (OD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:KOOK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1649 COLBY AVE
Mailing Address - Street 2:# 206
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3073
Mailing Address - Country:US
Mailing Address - Phone:714-335-3149
Mailing Address - Fax:310-546-5421
Practice Address - Street 1:3200 N SEPULVEDA BLVD
Practice Address - Street 2:E4
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2458
Practice Address - Country:US
Practice Address - Phone:310-546-5568
Practice Address - Fax:310-546-5421
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA12819 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist