MEDICARE: DR. YAT-CHOI KWONG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	G71385	CA

General Provider Information

NPI Number	:	1649315698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YAT-CHOI KWONG M.D.

Provider Business Mailing Address
First Line	:	1801 MARENGO ST RM 1G1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1365
Country	:	US
Telephone Number	:	323-409-3737
Fax Number	:	323-226-5049

Provider Business Practice Location Address
First Line	:	1801 MARENGO ST RM 1G1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1365
Country	:	US
Telephone Number	:	323-409-3737
Fax Number	:	323-226-5049

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	03/26/2019

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