Provider Demographics
NPI:1649964909
Name:HERZIG, KAREN JANG (OD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:JANG
Last Name:HERZIG
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 1:627 CUESTA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1201
Mailing Address - Country:US
Mailing Address - Phone:650-678-9967
Mailing Address - Fax:
Practice Address - Street 1:627 CUESTA AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1201
Practice Address - Country:US
Practice Address - Phone:650-678-9967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35514152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist