MEDICARE: AUDREY CHEN MOK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	A86641	CA

General Provider Information

NPI Number	:	1134188519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY CHEN MOK MD

Provider Business Mailing Address
First Line	:	3900 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-2615
Country	:	US
Telephone Number	:	562-988-8668
Fax Number	:	562-988-8660

Provider Business Practice Location Address
First Line	:	3900 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-2615
Country	:	US
Telephone Number	:	562-988-8668
Fax Number	:	562-988-8660

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	03/17/2016

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