1396855565 NPI number — MRS. DANIELLE ELIZABETH KWONG PA-C

Table of content: MRS. DANIELLE ELIZABETH KWONG PA-C (NPI 1396855565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396855565 NPI number — MRS. DANIELLE ELIZABETH KWONG PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KWONG
Provider First Name:
DANIELLE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARDY
Provider Other First Name:
DANIELLE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396855565
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3997
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOLIET
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60434-3997
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-741-2201
Provider Business Mailing Address Fax Number:
815-741-2285

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 N HAMMES AVE
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
JOLIET
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60435-8118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-741-2201
Provider Business Practice Location Address Fax Number:
815-741-2285
Provider Enumeration Date:
08/30/2006

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: 363AM0700X , with the licence number:  385000655 , 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)





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