Provider Demographics
NPI:1699785006
Name:KWOK, PHILIP (OD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:KWOK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 E. SECOND ST.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2007
Mailing Address - Country:US
Mailing Address - Phone:909-706-3899
Mailing Address - Fax:909-469-8640
Practice Address - Street 1:795 E. SECOND ST.
Practice Address - Street 2:SUITE 2
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766
Practice Address - Country:US
Practice Address - Phone:909-706-3899
Practice Address - Fax:909-469-8640
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11680T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMK0983571OtherDEA REGISTRATION
CA11680TOtherLICENSE
CA11680TOtherLICENSE
CAW0P11680AMedicare ID - Type Unspecified