NPIMap

Organization Active NPI

Bethel Eye Center Medical Corporation

Doing business as Bethel Eye Center

  • Ophthalmology Physician
  • Los Angeles, CA
National Provider Identifier
1972980191
Registry record updated Jun 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
G59023 Issued in CA
Legal business name
BETHEL EYE CENTER MEDICAL CORPORATION
Doing business as
Bethel Eye Center
Practice address
266 S Harvard Blvd
Suite 500
Los Angeles, CA 90004-4372
Phone
(213) 739-6900
NPI assigned
Apr 27, 2015
Last updated
Jun 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2022

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

Authorized official

Name
Dr. Wonkyu Pak, M.D.NPI 1376542894
Title
President
Phone
(310) 433-8156

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
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X G59023 CA Primary

Addresses

Primary practice location

266 S Harvard Blvd
Suite 500
Los Angeles, CA 90004-4372

Mailing address

266 S Harvard Blvd Ste 500
Los Angeles, CA 90004-4390
Phone (310) 433-8156

Other names 1

  • Bethel Eye Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150602000924 CA Part B Supplier - Clinic/Group Practice 1355662495 Receives reassigned benefits from 10 practitioners
Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory

Locations

266 S Harvard Blvd
Ste 500
Los Angeles, CA 90004
Phone (213) 739-6900

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1430092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656374400000",
    "number": "1972980191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "266 S HARVARD BLVD STE 500",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900044390",
            "telephone_number": "310-433-8156",
            "fax_number": "213-201-5399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "266 S HARVARD BLVD",
            "address_2": "SUITE 500",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900044372",
            "telephone_number": "213-739-6900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHEL EYE CENTER MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-27",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A",
        "authorized_official_last_name": "PAK",
        "authorized_official_first_name": "WONKYU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-433-8156",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "G59023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bethel Eye Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bethel Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2022; 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.