Healthcare Provider Details

I. General information

NPI: 1316901705
Provider Name (Legal Business Name): CHRISTOPHER N KWONG PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27650 FERRY RD SUITE 100
WARRENVILLE IL
60555-3845
US

IV. Provider business mailing address

27650 FERRY RD SUITE 100
WARRENVILLE IL
60555-3845
US

V. Phone/Fax

Practice location:
  • Phone: 630-225-2663
  • Fax: 630-225-2399
Mailing address:
  • Phone: 630-225-2663
  • Fax: 630-225-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-001674
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085-001674
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: