Healthcare Provider Details

I. General information

NPI: 1629068671
Provider Name (Legal Business Name): PHYLLIS MEI HUI KWOK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. PHYLLIS MEI HUI CHUNG

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 PONDFIELD RD
BRONXVILLE NY
10708-3809
US

IV. Provider business mailing address

77 PONDFIELD RD
BRONXVILLE NY
10708-3809
US

V. Phone/Fax

Practice location:
  • Phone: 914-337-4986
  • Fax:
Mailing address:
  • Phone: 914-337-4986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number212979
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number212979
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: