Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | G31296 | CA |
NPI | 1285610667 |
---|---|
Provider Name | Dr. Phillip K. Kwong |
First Address | Los Angeles, CA 90045 |
Second Address | Los Angeles, CA 90045-1543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2005 |
Last Update Date | 26/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A44713 | (02) | CA |