Healthcare Provider Details

I. General information

NPI: 1922559202
Provider Name (Legal Business Name): AMANDA KWOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 VAN NESS AVE
SAN FRANCISCO CA
94109
US

IV. Provider business mailing address

2025 VAN NESS AVE
SAN FRANCISCO CA
94109-3009
US

V. Phone/Fax

Practice location:
  • Phone: 650-515-8778
  • Fax:
Mailing address:
  • Phone: 650-515-8778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number75723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: