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General NPI Number Information
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NPI Number | 1821140534
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Entity Type | Individual
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Provider Name | JENIFER KENI KEIKO ISHIZAKI CHUNG O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 3400 DELTA FAIR BLVD EYECARE CLINIC-OPTOMETRY
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City | ANTIOCH
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State | CA
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Zip | 94509-4004
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Country | US
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Telephone | 925-779-4378
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Fax | 925-779-5421
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Provider Business Mailing Address
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Address Line | 4501 SAND CREEK RD EYECARE CLINIC- OPTOMETRY
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City | ANTIOCH
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State | CA
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Zip | 94531-8687
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Country | US
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Telephone |
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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 | 550
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11660
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License Number State | CA
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