MEDICARE: DR. CARL KWONG OD

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	152W00000X	Optometrist	8769T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	533381	OTHER		OE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962463604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL KWONG OD

Provider Business Mailing Address
First Line	:	PO BOX 31903
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94131-0903
Country	:	US
Telephone Number	:	415-823-1199
Fax Number	:	408-923-3303

Provider Business Practice Location Address
First Line	:	1937-A TULLY RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95122
Country	:	US
Telephone Number	:	408-923-0400
Fax Number	:	408-923-3303

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	07/08/2011

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