NPIMap

Organization Active NPI

Azusa Optometry Group, Inc.

  • Optometrist
  • Hacienda Heights, CA
National Provider Identifier
1073544896
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
11162-T Issued in CA
Legal business name
AZUSA OPTOMETRY GROUP, INC.
Practice address
17188 Colima Rd
Suite C
Hacienda Heights, CA 91745-6787
Phone
(626) 810-5503
NPI assigned
Jul 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Martin Sung Kim, O.D.NPI 1801827795
Title
President
Phone
(626) 810-5503

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 11162-T CA Primary

Addresses

Primary practice location

17188 Colima Rd
Suite C
Hacienda Heights, CA 91745-6787

Mailing address

17188 Colima Rd
Suite C
Hacienda Heights, CA 91745-6787

National Provider Directory

National Provider Directory

Locations

17188 Colima Rd
Ste C
Hacienda Heights, CA 91745
Phone (626) 810-5503

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073544896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17188 COLIMA RD",
            "address_2": "SUITE C",
            "city": "HACIENDA HEIGHTS",
            "state": "CA",
            "postal_code": "917456787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17188 COLIMA RD",
            "address_2": "SUITE C",
            "city": "HACIENDA HEIGHTS",
            "state": "CA",
            "postal_code": "917456787",
            "telephone_number": "626-810-5503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AZUSA OPTOMETRY GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "SUNG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-810-5503",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11162-T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hacienda Heights, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.