Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT34613 | CA |
NPI | 1003427469 |
---|---|
Provider Name | Tiffany Christine Kwong |
First Address | Temple City, CA 91780-1833 |
Second Address | Temple City, CA 91780-1833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2020 |
Last Update Date | 28/08/2020 |