Provider Demographics
NPI:1649667072
Name:KWOK INTERNAL MEDICINE A MEDICAL CORPORATION
Entity type:Organization
Organization Name:KWOK INTERNAL MEDICINE A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:KWOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-925-3617
Mailing Address - Street 1:1300 S ELISEO DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2023
Mailing Address - Country:US
Mailing Address - Phone:415-925-3617
Mailing Address - Fax:415-925-3597
Practice Address - Street 1:1300 S ELISEO DR
Practice Address - Street 2:SUITE 203
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2023
Practice Address - Country:US
Practice Address - Phone:415-925-3617
Practice Address - Fax:415-925-3597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty