Individual provider Active NPI

Tiffany Christine Kwong, OD

  • Optometrist
  • Temple City, CA
National Provider Identifier
1003427469
Registry record updated Aug 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT34613 Issued in CA
Practice address
5803 Rosemead Blvd
Temple City, CA 91780-1833
Phone
(626) 287-8505
Fax
(626) 287-2645
NPI assigned
Aug 11, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT34613 CA Primary

Addresses

Primary practice location

5803 Rosemead Blvd
Temple City, CA 91780-1833

Mailing address

5803 Rosemead Blvd
Temple City, CA 91780-1833
Phone (626) 277-6973

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200820002814 CA Practitioner - Optometry 9234555293 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Annessa Du, O.D., a Professional CorporationGroup PAC ID 8729445010, 3 clinicians

Practice addresses (Care Compare)

11346 Mountain View Ave
Suite B
Loma Linda, CA 92354-3833
Phone (909) 796-0101

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34613CAMDGeneral Practice Dentistry
OPT34613CAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Paulina T.Q. Han O.D. Inc. Optometrist CurrentSince Aug 10, 2020 Accepting new patients
Jeannie Situ, O.D., Inc. Optometrist CurrentSince Jan 1, 2021 Accepting new patients

Locations

5803 Rosemead Blvd
Temple City, CA 91780
Phone (626) 287-8505

12234 Palmdale Rd
Victorville, CA 92392
Phone (760) 493-3279

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598572800000",
    "number": "1003427469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5803 ROSEMEAD BLVD",
            "city": "TEMPLE CITY",
            "state": "CA",
            "postal_code": "917801833",
            "telephone_number": "626-277-6973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5803 ROSEMEAD BLVD",
            "city": "TEMPLE CITY",
            "state": "CA",
            "postal_code": "917801833",
            "telephone_number": "626-287-8505",
            "fax_number": "626-287-2645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWONG",
        "first_name": "TIFFANY",
        "middle_name": "CHRISTINE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-11",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT34613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Temple City, CA

Sources for this page

Verify at the official NPI Registry.