Healthcare Provider Details

I. General information

NPI: 1316061237
Provider Name (Legal Business Name): ELAINE SEONOG KWON O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELAINE SEONOG YOO O.D.

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 IRVING ST
SAN FRANCISCO CA
94122-1621
US

IV. Provider business mailing address

2380 IRVING ST
SAN FRANCISCO CA
94122-1621
US

V. Phone/Fax

Practice location:
  • Phone: 415-566-8199
  • Fax: 415-566-8198
Mailing address:
  • Phone: 415-566-8199
  • Fax: 415-566-8198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number11788T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: