Healthcare Provider Details

I. General information

NPI: 1295060432
Provider Name (Legal Business Name): SHEILA CHE LAN KWOK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. SHEILA WONG

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3544 GRIFFITH PARK BLVD
LOS ANGELES CA
90027-1405
US

IV. Provider business mailing address

3544 GRIFFITH PARK BLVD
LOS ANGELES CA
90027-1405
US

V. Phone/Fax

Practice location:
  • Phone: 323-661-7860
  • Fax: 323-661-7860
Mailing address:
  • Phone: 323-661-7860
  • Fax: 323-661-7860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAFE24415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: