Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2015025849 | MO |
Y | 2080P0201X | Pediatric Allergist | 2015025849 | MO |
NPI | 1326302902 |
---|---|
Provider Name | Dr. Christina Grace Kwong |
First Address | Saint Louis, MO 63110-1002 |
Second Address | Saint Louis, MO 63110-1002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2012 |
Last Update Date | 04/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200043292 | (05) | MO |
WUPI ENROLLED | (05) | IL |