Provider Demographics
NPI:1235689449
Name:KWONG, JENNY (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:
Last Name:KWONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 BRICKELL BAY DR APT 3407
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3249
Mailing Address - Country:US
Mailing Address - Phone:787-244-3899
Mailing Address - Fax:
Practice Address - Street 1:1155 BRICKELL BAY DRIVE APT 3407
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-3249
Practice Address - Country:US
Practice Address - Phone:787-244-3899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 5284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist