Provider Demographics
NPI:1033257746
Name:KWONG, HENRY MARK JR (MD)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:MARK
Last Name:KWONG
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1750 E GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5505
Mailing Address - Country:US
Mailing Address - Phone:602-242-4928
Mailing Address - Fax:602-249-4813
Practice Address - Street 1:1750 E GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5505
Practice Address - Country:US
Practice Address - Phone:602-242-4928
Practice Address - Fax:602-249-4813
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2020-04-29
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Provider Licenses
StateLicense IDTaxonomies
AZ36537207WX0107X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ220709Medicaid
AZ220709Medicaid
AZD62755Medicare UPIN