Healthcare Provider Details

I. General information

NPI: 1649492174
Provider Name (Legal Business Name): VICTOR KWOK MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 LILIHA STREET MOD 105
HONOLULU HI
96817
US

IV. Provider business mailing address

820 MILILANI STREET SUITE 702A
HONOLULU HI
96813
US

V. Phone/Fax

Practice location:
  • Phone: 808-538-1929
  • Fax: 808-538-1920
Mailing address:
  • Phone: 808-523-9363
  • Fax: 808-523-9418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD-12488
License Number StateHI

VIII. Authorized Official

Name: ARLENE SALVADOR
Title or Position: BILLER
Credential:
Phone: 808-523-9363