MEDICARE: WARREN T KWOK 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	207Q00000X	Family Medicine Physician	27217	TN
2	207Q00000X	Family Medicine Physician	19093	MS

General Provider Information

NPI Number	:	1760411813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WARREN T KWOK M.D.

Provider Business Mailing Address
First Line	:	965 RIDGE LAKE BLVD STE 103
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-9446
Country	:	US
Telephone Number	:
Fax Number	:	901-227-8591

Provider Business Practice Location Address
First Line	:	8990 GERMANTOWN RD
Second Line	:
City	:	OLIVE BRANCH
State	:	MS
Zip	:	38654-8532
Country	:	US
Telephone Number	:	662-893-1160
Fax Number	:	662-893-1166

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

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	03/18/2020

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