Individual
DR. SUSAN SOSUN KWONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
12906T
CA
152W00000X
Optometrist
Primary
OD00004010
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OD00004010
OPTOMETRY LICENSE NUMBER
WA
01
—
OPT 12906T
OPTOMETRY LICENSE NUMBER
CA
Enumeration date
01/29/2007
Last updated
01/15/2019
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