Provider Demographics
NPI:1033538004
Name:KWONG, JERRY GINKAY (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:GINKAY
Last Name:KWONG
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 1:1245 WILSHIRE BLVD STE 703
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4807
Mailing Address - Country:US
Mailing Address - Phone:213-977-0419
Mailing Address - Fax:213-977-0225
Practice Address - Street 1:1245 WILSHIRE BLVD STE 580
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-5854
Practice Address - Country:US
Practice Address - Phone:213-977-0419
Practice Address - Fax:213-977-0225
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036142977207RC0000X
IL036.142977207RC0001X
CA143237207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease