Healthcare Provider Details

I. General information

NPI: 1124039516
Provider Name (Legal Business Name): TAI C KWONG PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX 608
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 608
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-5654
  • Fax: 585-273-3003
Mailing address:
  • Phone: 585-275-5654
  • Fax: 585-273-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QC1000X
TaxonomyChemistry Pathology Specialist/Technologist
License NumberKWONT1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: