Paul Kwon an Optometric Corporation

Primary specialty

OptometristTaxonomy code 152W00000X

License

14685TLG Issued in CA

Legal business name

PAUL KWON AN OPTOMETRIC CORPORATION

Practice address

28505 Hesperian Blvd
Hayward, CA 94545-5008

Phone

(510) 732-6121

NPI assigned

May 16, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Soo Han Kwon, ODNPI 1477994549

Title

Owner

Phone

(818) 331-8601

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Soo Han Kwon, O.D.

  • Optometrist
  • Hayward, CA
  • NPI 1477994549
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1494892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614038400000",
    "number": "1407383862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8438 SHEFFIELD RD",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917751825",
            "telephone_number": "818-331-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28505 HESPERIAN BLVD",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945455008",
            "telephone_number": "510-732-6121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7447 N Figueroa St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900411721",
            "country_code": "US",
            "telephone_number": "181-833-1860",
            "fax_number": "818-331-8601",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7447 N Figueroa St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900411721",
            "country_code": "US",
            "telephone_number": "181-833-1860",
            "fax_number": "818-331-8601",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1051 W Burbank Blvd",
            "address_purpose": "LOCATION",
            "city": "Burbank",
            "state": "CA",
            "postal_code": "915061421",
            "country_code": "US",
            "telephone_number": "818-331-8601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PAUL KWON AN OPTOMETRIC CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-16",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A",
        "authorized_official_last_name": "KWON",
        "authorized_official_first_name": "SOO HAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-331-8601",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14685TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Hayward, CA
• Providers in Hayward, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.