1346357886 NPI number — DR. HELEN D KWONG MD

Table of content: DR. HELEN D KWONG MD (NPI 1346357886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346357886 NPI number — DR. HELEN D KWONG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KWONG
Provider First Name:
HELEN
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346357886
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2801 MATHERS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62711-7064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-789-3600
Provider Business Mailing Address Fax Number:
217-492-9643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 MATHERS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62711-7064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-789-3600
Provider Business Practice Location Address Fax Number:
217-492-9643
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  39088 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 036119937 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 14D0435365 . This is a "CLIA CFP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 020057300 . This is a "BLACK LUNG" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: CD7143 . This is a "RR MEDICARE GRP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 08421024 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 133586700 . This is a "ACS-OWCP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 14D0949277 . This is a "CLIA CERT PGW" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 6394P . This is a "CATERPILLAR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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