Healthcare Provider Details

I. General information

NPI: 1831176171
Provider Name (Legal Business Name): LEON S. KWEI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MACCORKLE AVE SE
CHARLESTON WV
25304-1227
US

IV. Provider business mailing address

3200 MACCORKLE AVE SE
CHARLESTON WV
25304-1227
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-4172
  • Fax: 304-388-4155
Mailing address:
  • Phone: 304-388-4172
  • Fax: 304-388-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number15906
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number15096
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: