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General NPI Number Information
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NPI Number | 1922336817
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Entity Type | Organization
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Legal Business Name | HENRY M KWONG, M.D. A PROF MED CORP
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Dates
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Enumeration Date | 12/03/2009
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Last Update Date | 12/03/2009
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Provider Practice Location Address
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Address Line | 607 RUE DE BRILLE
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City | NEW IBERIA
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State | LA
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Zip | 70563
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Country | US
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Telephone | 337-367-1247
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Fax | 337-365-7496
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Provider Business Mailing Address
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Address Line | 607 RUE DE BRILLE
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City | NEW IBERIA
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State | LA
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Zip | 70563
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Country | US
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Telephone | 337-367-1247
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Fax | 337-365-7496
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Authorized Official
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Title or Position | PRESIDENT
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Name | HENRY MARK KWONG, M.D. SR.
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Credential | M.D.
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Telephone | 337-367-1247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 012632
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License Number State | LA
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