Provider Demographics
NPI:1053343137
Name:GREGORY Y. KAME, O.D., F.A.A.O., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:GREGORY Y. KAME, O.D., F.A.A.O., A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:YUJI
Authorized Official - Last Name:KAME
Authorized Official - Suffix:
Authorized Official - Credentials:OD FAAO
Authorized Official - Phone:213-628-7419
Mailing Address - Street 1:334B E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-4203
Mailing Address - Country:US
Mailing Address - Phone:213-628-7419
Mailing Address - Fax:213-620-9110
Practice Address - Street 1:334B E 2ND ST STE 802
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-4203
Practice Address - Country:US
Practice Address - Phone:213-628-7419
Practice Address - Fax:213-620-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11157T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADP3156OtherPTAN
CAWY7779OtherPTIN