Provider Demographics
NPI:1457345613
Name:KWOK, SHIU YUEN (MD)
Entity Type:Individual
Prefix:
First Name:SHIU
Middle Name:YUEN
Last Name:KWOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 PACIFIC AVE
Mailing Address - Street 2:# 702
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4457
Mailing Address - Country:US
Mailing Address - Phone:415-788-0810
Mailing Address - Fax:415-788-1009
Practice Address - Street 1:728 PACIFIC AVE
Practice Address - Street 2:# 702
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4457
Practice Address - Country:US
Practice Address - Phone:415-788-0810
Practice Address - Fax:628-228-3187
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43512207W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G435121Medicaid
A89780Medicare UPIN
CA00G435121Medicare ID - Type Unspecified