Doctor Name: | KEN K KWOK |
NPI Number: | 1366600322 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 22808 |
Business Practice Address: | 1384 Battlefield Pkwy Fort Oglethorpe, GA - 307424010 |
Business Phone Number: | 7068588083 |
Business Fax Number: | 7068612745 |
Mailing Address: | 869 Trailside Ln Sw, MARIETTA |
State: | GA |
Postal Code: | 300643077 |
Phone Number: | 7704270005 |
Fax Number: | 7704270260 |
NPI Enumeration Date: | 05/27/2008 |
NPI Last Update Date: | 05/27/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207QA0505X |
License Number: | 22808 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Family Medicine |
Taxonomy Specialization: | Adult Medicine |
Taxonomy Definition: |