Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A17906 | CA |
NPI | 1063909109 |
---|---|
Provider Name | Eric Kwo |
First Address | Fountain Valley, CA 92708-6748 |
Second Address | Manchester, CT 06040-4139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2018 |
Last Update Date | 25/04/2021 |