Provider Demographics
NPI:1033776430
Name:WING QUAN, KIMBERLEE (DO)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:
Last Name:WING QUAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 US HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2950
Mailing Address - Country:US
Mailing Address - Phone:908-756-2424
Mailing Address - Fax:
Practice Address - Street 1:459 WATCHUNG AVE
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-4945
Practice Address - Country:US
Practice Address - Phone:908-756-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11557200204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM