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General NPI Number Information
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NPI Number | 1700023520
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Entity Type | Individual
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Provider Name | GIDEON PUIYUEN KWOK DO
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Gender | Male
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Dates
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Enumeration Date | 01/15/2009
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Last Update Date | 01/15/2009
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Provider Practice Location Address
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Address Line | 12225 FOOTHILL BLVD #120
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739
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Country | US
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Telephone | 909-922-5100
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Fax | 909-922-5150
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Provider Business Mailing Address
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Address Line | 12225 FOOTHILL BLVD STE 120
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-9359
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Country | US
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Telephone | 909-922-5100
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Fax | 909-922-5150
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 20A8908
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License Number State | CA
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