Healthcare Provider Details

I. General information

NPI: 1992457923
Provider Name (Legal Business Name): KELLY KWOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13934 N 59TH AVE STE 160
GLENDALE AZ
85306-4168
US

IV. Provider business mailing address

13934 N 59TH AVE STE 160
GLENDALE AZ
85306-4168
US

V. Phone/Fax

Practice location:
  • Phone: 480-935-0614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: