Provider Demographics
NPI:1285653980
Name:KWONG, BERTRAM (OD)
Entity Type:Individual
Prefix:DR
First Name:BERTRAM
Middle Name:
Last Name:KWONG
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 1:9959 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3827
Mailing Address - Country:US
Mailing Address - Phone:714-995-2020
Mailing Address - Fax:714-995-4208
Practice Address - Street 1:9959 WALKER ST
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-3827
Practice Address - Country:US
Practice Address - Phone:714-995-2020
Practice Address - Fax:714-995-4208
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11682T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist