Provider Demographics
NPI:1861430902
Name:KWOK, WEI WAH (MD)
Entity type:Individual
Prefix:
First Name:WEI
Middle Name:WAH
Last Name:KWOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 LAGUNA RD STE A
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3614
Mailing Address - Country:US
Mailing Address - Phone:714-525-8822
Mailing Address - Fax:714-525-5193
Practice Address - Street 1:150 LAGUNA RD STE A
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3614
Practice Address - Country:US
Practice Address - Phone:714-525-8822
Practice Address - Fax:714-525-5193
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90368207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA90368Medicare PIN