MEDICARE: DR. AVON WAI KWONG 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
1	152W00000X	Optometrist	9376TPL	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427029123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AVON WAI KWONG OD

Provider Business Mailing Address
First Line	:	611 BROADWAY
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94133-4405
Country	:	US
Telephone Number	:	415-982-0388
Fax Number	:	415-217-7010

Provider Business Practice Location Address
First Line	:	611 BROADWAY
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94133-4405
Country	:	US
Telephone Number	:	415-982-0388
Fax Number	:	415-217-7010

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	08/06/2010

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