Healthcare Provider Details

I. General information

NPI: 1275783607
Provider Name (Legal Business Name): JAY KWOK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 W CHAPMAN AVE SUITE 204
ORANGE CA
92868-2872
US

IV. Provider business mailing address

2041 N BRECKENRIDGE ST
ORANGE CA
92867-2906
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-7000
  • Fax:
Mailing address:
  • Phone: 714-889-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: