Healthcare Provider Details

I. General information

NPI: 1396494555
Provider Name (Legal Business Name): NATHANIEL DER-LIN KWOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 PGA BLVD STE 440
PALM BEACH GARDENS FL
33410-2825
US

IV. Provider business mailing address

3401 PGA BLVD STE 440
PALM BEACH GARDENS FL
33410-2825
US

V. Phone/Fax

Practice location:
  • Phone: 561-406-4469
  • Fax: 561-437-8255
Mailing address:
  • Phone: 561-406-4469
  • Fax: 561-437-8255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME173717
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: