Healthcare Provider Details

I. General information

NPI: 1164000683
Provider Name (Legal Business Name): JEFFREY WING KEE KWONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PARNASSUS AVENUE MU 320 WEST
SAN FRANCISCO CA
94143
US

IV. Provider business mailing address

500 PARNASSUS AVENUE MU 320 WEST
SAN FRANCISCO CA
94143
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-6548
  • Fax:
Mailing address:
  • Phone: 415-476-6548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: