Healthcare Provider Details

I. General information

NPI: 1649667072
Provider Name (Legal Business Name): KWOK INTERNAL MEDICINE A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 SIR FRANCIS DRAKE BLVD
SAN ANSELMO CA
94960-1916
US

IV. Provider business mailing address

PO BOX 6671
SANTA ROSA CA
95406-0671
US

V. Phone/Fax

Practice location:
  • Phone: 415-925-3617
  • Fax: 415-925-3597
Mailing address:
  • Phone: 415-925-3617
  • Fax: 415-925-3597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL K. KWOK
Title or Position: OWNER
Credential: MD
Phone: 415-925-3617