Provider Demographics
NPI:1134188519
Name:MOK, AUDREY CHEN (MD)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:CHEN
Last Name:MOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3900 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2615
Mailing Address - Country:US
Mailing Address - Phone:562-988-8668
Mailing Address - Fax:562-988-8660
Practice Address - Street 1:3900 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2615
Practice Address - Country:US
Practice Address - Phone:562-988-8668
Practice Address - Fax:562-988-8660
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86641207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10151Medicare UPIN
CA5236340001Medicare NSC
CAWA86641CMedicare ID - Type Unspecified