Provider Demographics
NPI:1629844741
Name:MOK, KAI KWAN TOM
Entity Type:Individual
Prefix:
First Name:KAI
Middle Name:KWAN TOM
Last Name:MOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 S EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6208
Mailing Address - Country:US
Mailing Address - Phone:760-290-8170
Mailing Address - Fax:
Practice Address - Street 1:2122 S EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6208
Practice Address - Country:US
Practice Address - Phone:760-290-8170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator