Healthcare Provider Details

I. General information

NPI: 1750450276
Provider Name (Legal Business Name): LOUIS MATTHEW KWONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST RM 4L1
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

1000 W CARSON ST # 422
TORRANCE CA
90502-2059
US

V. Phone/Fax

Practice location:
  • Phone: 424-306-7874
  • Fax: 310-533-2211
Mailing address:
  • Phone: 424-306-7874
  • Fax: 310-533-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberG55440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: