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General NPI Number Information
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NPI Number | 1093060444
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Entity Type | Individual
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Provider Name | DOAN TRANG KWAK OD
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Gender | Female
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Dates
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Enumeration Date | 07/20/2012
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Last Update Date | 03/19/2018
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Provider Practice Location Address
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Address Line | 1200 W GODFREY AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19141-3323
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Country | US
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Telephone | 215-276-6000
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Fax | 215-276-1329
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Provider Business Mailing Address
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Address Line | 200 MALL BLVD
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-2902
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Country | US
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Telephone | 610-337-1580
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Fax | 610-337-2133
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG002671
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License Number State | PA
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