Healthcare Provider Details

I. General information

NPI: 1164827093
Provider Name (Legal Business Name): COASTAL ER II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 S STAPLES ST SUITE 106
CORPUS CHRISTI TX
78411-2105
US

IV. Provider business mailing address

PO BOX 6040
CORPUS CHRISTI TX
78466-6040
US

V. Phone/Fax

Practice location:
  • Phone: 361-991-0911
  • Fax: 512-852-4625
Mailing address:
  • Phone: 361-991-0911
  • Fax: 512-852-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER KWON
Title or Position: LLC BOARD MEMBER
Credential: MD
Phone: 361-991-0911