Active NPI
Mimia Wen, OD
- Optometrist
- Costa Mesa, CA
National Provider Identifier
1174189716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT34428TLG
- Practice address
- 2651 Irvine Ave Ste 120
Costa Mesa, CA 92627-6620 - Phone
- (949) 432-7894
- Fax
- (949) 432-7880
- NPI assigned
- May 17, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT34428TLG | CA | Primary |
Addresses
Primary practice location
2651 Irvine Ave Ste 120
Costa Mesa, CA 92627-6620
Mailing address
4505 Barranca Pkwy Ste C
Irvine, CA 92604-4797
Phone (949) 857-0676
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230712003200 | CA | Practitioner - Optometry | 9133547326 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34428 | CA | MD | General Practice Dentistry |
| OPT34428TLG | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689724800000",
"number": "1174189716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4505 BARRANCA PKWY STE C",
"city": "IRVINE",
"state": "CA",
"postal_code": "926044797",
"telephone_number": "949-857-0676",
"fax_number": "949-857-2175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2651 IRVINE AVE STE 120",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926276620",
"telephone_number": "949-432-7894",
"fax_number": "949-432-7880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEN",
"first_name": "MIMIA",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-17",
"last_updated": "2023-07-19",
"certification_date": "2023-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT34428TLG",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Costa Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.