Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | G65879 | CA |
NPI | 1003857020 |
---|---|
Provider Name | Eugene Lawrence Kwong |
First Address | Emeryville, CA 94608-1803 |
Second Address | Colton, CA 92324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 15/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F16618 | (02) | CA |