NPIMap

Organization Active NPI

Golden San Gabriel Optometric Vision Center

  • Optometrist
  • San Gabriel, CA
National Provider Identifier
1740216936
Registry record updated Mar 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
9727 Issued in CA
Legal business name
GOLDEN SAN GABRIEL OPTOMETRIC VISION CENTER
Practice address
140 W Valley Blvd
#115
San Gabriel, CA 91776-3760
Phone
(626) 288-8023
Fax
(626) 288-8326
NPI assigned
Jun 23, 2006
Last updated
Mar 27, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2014

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

Authorized official

Name
Dr. Jiyen Shin, O.D.NPI 1760411169
Title
Owner/Optometris
Phone
(626) 288-8023

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
Optometrist 152W00000X 9727 CA Primary

Addresses

Primary practice location

140 W Valley Blvd
#115
San Gabriel, CA 91776-3760

Mailing address

140 W Valley Blvd
#115
San Gabriel, CA 91776-3760
Phone (626) 288-8023

Other identifiers 1

IdentifierTypeStateIssuer
GSD001490MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040326000761 CA Part B Supplier - Clinic/Group Practice 5698667400 Receives reassigned benefits from 19 practitioners
Practice locations: San Gabriel, CA

National Provider Directory

National Provider Directory

Locations

1015 Nogales St
Ste 109A
Rowland Heights, CA 91748
Phone (626) 965-8698

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395878400000",
    "number": "1740216936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 W VALLEY BLVD",
            "address_2": "#115",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917763760",
            "telephone_number": "626-288-8023",
            "fax_number": "626-288-8326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 W VALLEY BLVD",
            "address_2": "#115",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917763760",
            "telephone_number": "626-288-8023",
            "fax_number": "626-288-8326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN SAN GABRIEL OPTOMETRIC VISION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-23",
        "last_updated": "2014-03-27",
        "status": "A",
        "authorized_official_last_name": "SHIN",
        "authorized_official_first_name": "JIYEN",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIS",
        "authorized_official_telephone_number": "626-288-8023",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "9727",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GSD001490",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Gabriel, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.