MEDICARE: KEITH KWOK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085N0700X	Neuroradiology Physician	A96381	CA
2	2085R0202X	Diagnostic Radiology Physician	A96381	CA

General Provider Information

NPI Number	:	1104807569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH KWOK M.D.

Provider Business Mailing Address
First Line	:	1530 NORTH BESSIE AVENUE
Second Line	:	SUITE 108
City	:	TRACY
State	:	CA
Zip	:	95376
Country	:	US
Telephone Number	:	209-833-2393
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 NORTH BESSIE AVENUE
Second Line	:	SUITE 108
City	:	TRACY
State	:	CA
Zip	:	95376
Country	:	US
Telephone Number	:	209-833-2393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	10/01/2013

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