Provider Demographics
NPI:1548741929
Name:KWONG, IRIS CHI-TING (OD)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:CHI-TING
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 1:29238 CHUTNEY RD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-8711
Mailing Address - Country:US
Mailing Address - Phone:510-881-3633
Mailing Address - Fax:
Practice Address - Street 1:2855 STEVENS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-6709
Practice Address - Country:US
Practice Address - Phone:408-243-9394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34075TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist