Healthcare Provider Details

I. General information

NPI: 1235194127
Provider Name (Legal Business Name): KWOK SUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 W. PIERCE ST SUITE 104
CARLSBAD NM
88220-5117
US

IV. Provider business mailing address

2324 W PIERCE ST
CARLSBAD NM
88220
US

V. Phone/Fax

Practice location:
  • Phone: 575-885-0805
  • Fax: 575-885-0793
Mailing address:
  • Phone: 575-628-5051
  • Fax: 575-628-0493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2002-0383
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: