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NPI Code Detail

MEDICARE: KWOK FUNG CHAN OD

MEDICARE:   KWOK FUNG  CHAN  OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist35087CA

General Provider Information

NPI Number : 1407508385
Entity Type Code : Individual
Provider Name (Legal Business Name) : KWOK FUNG CHAN OD
Provider Business Mailing Address
First Line : 2650 JAMACHA RD STE 155
Second Line :
City : EL CAJON
State : CA
Zip : 92019-4319
Country : US
Telephone Number : 619-670-6296
Fax Number :
Provider Business Practice Location Address
First Line : 2650 JAMACHA RD STE 155
Second Line :
City : EL CAJON
State : CA
Zip : 92019-4319
Country : US
Telephone Number : 619-670-6296
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2022
Last Update Date : 01/29/2024

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Directions to “ KWOK FUNG CHAN OD” Practice Location

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