Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | G0748 | TX |
NPI | 1003092644 |
---|---|
Provider Name | Dr. Stella Suk-Yee Kwong |
First Address | Garland, TX 75044-7011 |
Second Address | Garland, TX 75044-7011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2008 |
Last Update Date | 14/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B24181 | (02) | TX |