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General NPI Number Information
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NPI Number | 1548741929
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Entity Type | Individual
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Provider Name | IRIS CHI-TING KWONG OD
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Gender | Female
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Dates
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Enumeration Date | 08/23/2018
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Last Update Date | 08/23/2018
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Provider Practice Location Address
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Address Line | 2855 STEVENS CREEK BLVD
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City | SANTA CLARA
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State | CA
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Zip | 95050-6709
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Country | US
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Telephone | 408-243-9394
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Fax |
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Provider Business Mailing Address
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Address Line | 29238 CHUTNEY RD
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City | HAYWARD
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State | CA
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Zip | 94544-8711
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Country | US
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Telephone | 510-881-3633
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Fax |
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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 | 34075TLG
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License Number State | CA
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