Individual provider Active NPI

Mia M Hung, O.D.

  • Optometrist
  • Chino, CA
National Provider Identifier
1720191505
Registry record updated Dec 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT 9757 TPA Issued in CA
Practice address
14335 Pipeline Ave
Chino, CA 91710-5642
Phone
(909) 628-8860
Fax
(909) 628-6120
NPI assigned
Aug 16, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 28, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT 9757 TPA CA Primary

Addresses

Primary practice location

14335 Pipeline Ave
Chino, CA 91710-5642

Mailing address

21078 Jewel CT
Diamond Bar, CA 91765-4038
Phone (909) 628-8860

Other identifiers 1

IdentifierTypeStateIssuer
SD0097570MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, CA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080228000199 TX Practitioner - Optometry 2860576972 Reassigns benefits to 1 organization
I20120131000246 CA Practitioner - Optometry 2860576972 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

14461 Merced Ave
Suite 101
Baldwin Park, CA 91706-5173
Phone (626) 939-4588

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT 9757 TPACAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Innova Healthcare Optometrist Current Accepting new patients
Primigenia Optometry Inc Optometrist CurrentSince Aug 5, 2010 Accepting new patients
Today'S Vision Baybrook Associates PA Optometrist Past Accepting new patients

Locations

14461 Merced Ave
Ste 101
Baldwin Park, CA 91706
Phone (626) 939-4588

14335 Pipeline Ave
Ste A5
Chino, CA 91710
Phone (909) 628-8860

14510 Baldwin Park Towne Ctr
Ste G3
Irwindale, CA 91706
Phone (626) 939-4588

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356652800000",
    "number": "1720191505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21078 JEWEL CT",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917654038",
            "telephone_number": "909-628-8860",
            "fax_number": "909-628-6120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14335 PIPELINE AVE",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917105642",
            "telephone_number": "909-628-8860",
            "fax_number": "909-628-6120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUNG",
        "first_name": "MIA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-16",
        "last_updated": "2012-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT 9757 TPA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0097570",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chino, CA

Sources for this page

Verify at the official NPI Registry.