Ken Imoto, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

5286T Issued in CA

Practice address

11436 Artesia Blvd
Suite D
Artesia, CA 90701-3859

Phone

(562) 860-1717

Fax

(562) 865-5184

NPI assigned

Oct 26, 2006

Last updated

Oct 19, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Artesia I Care Optometry

  • Optometrist
  • Artesia, CA
  • NPI 1306235387
  NPD (past) Authorized official
• Bryan Imoto O.D. Optometric Corporation

  dba Artesia I Care Optometry

  • Optometrist
  • Artesia, CA
  • NPI 1073121380
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350604800000",
    "number": "1043395999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11436 ARTESIA BLVD",
            "address_2": "SUITE D",
            "city": "ARTESIA",
            "state": "CA",
            "postal_code": "907013859",
            "telephone_number": "562-860-1717",
            "fax_number": "562-865-5184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11436 ARTESIA BLVD",
            "address_2": "SUITE D",
            "city": "ARTESIA",
            "state": "CA",
            "postal_code": "907013859",
            "telephone_number": "562-860-1717",
            "fax_number": "562-865-5184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMOTO",
        "first_name": "KEN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2012-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "5286T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0052860",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eugene Humphries, D.D.S.
• Sung Hwan Hwang, L.AC.
• Tzong-Yueh Hwang, M.D.
• Amanche Ndonwa Ibe, DDS
• Bryan Takanori Imoto, BRYAN IMOTO O.D.
• Ken Iwaki, D.C.
• Mayra Lupe Jacobo
• Arash Jahanbakhsh, DMD
• Anasuyaben Dahyalal Jani, NP
• Michael Tuazon Jarvina

• Optometrist in Artesia, CA
• Providers in Artesia, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.