Healthcare Provider Details

I. General information

NPI: 1457420457
Provider Name (Legal Business Name): CHI YIN GABRIEL KWONG PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5909 HARRY HINES BLVD. UT SOUTHWESTERN MEDICAL CENTER, PHARMACY
DALLAS TX
75390-9236
US

IV. Provider business mailing address

9209 GRANT DR
ROWLETT TX
75088-4479
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-1075
  • Fax: 214-645-1074
Mailing address:
  • Phone: 972-475-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number25432
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number25432
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: