Provider Demographics
NPI:1922187855
Name:KWAN, NANCY SUK-YING (OD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:SUK-YING
Last Name:KWAN
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 1:9596 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-5034
Mailing Address - Country:US
Mailing Address - Phone:909-989-1791
Mailing Address - Fax:909-222-6785
Practice Address - Street 1:9596 BASELINE RD
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-5034
Practice Address - Country:US
Practice Address - Phone:909-989-1791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT11365T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist