1780805424 NPI number — LOUIS M. KWONG, M.D., A MEDICAL CORPORATION

Table of content: (NPI 1780805424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780805424 NPI number — LOUIS M. KWONG, M.D., A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUIS M. KWONG, M.D., A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1780805424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9663 SANTA MONICA BLVD
Provider Second Line Business Mailing Address:
SUITE 1230
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90210-4303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-399-5480
Provider Business Mailing Address Fax Number:
310-399-5490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9675 BRIGHTON WAY
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
BEVERLY HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90210-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-399-5480
Provider Business Practice Location Address Fax Number:
310-399-5490
Provider Enumeration Date:
05/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KWONG
Authorized Official First Name:
LOUIS
Authorized Official Middle Name:
MATTHEW
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
310-399-5480

Provider Taxonomy Codes

  • Taxonomy code: 207XS0114X , with the licence number:  G55440 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: W21411 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200348500 . This is a "DOL-OWCP" identifier . This identifiers is of the category "OTHER".