Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OD-953 | HI |
NPI | 1003442930 |
---|---|
Provider Name | Jennifer W. Q. Kwock |
First Address | Honolulu, HI 96814-2118 |
Second Address | Honolulu, HI 96814-2118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2020 |
Last Update Date | 10/08/2021 |