Healthcare Provider Details

I. General information

NPI: 1043536832
Provider Name (Legal Business Name): FEI LI KUANG M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST STE 18-250
CHICAGO IL
60611-5980
US

IV. Provider business mailing address

177 FORT WASHINGTON AVE
NEW YORK NY
10032-3733
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8624
  • Fax: 312-695-6070
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number036150847
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number266986
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: