Provider Demographics
NPI:1043309909
Name:KWONG, PEARL CHU (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:PEARL
Middle Name:CHU
Last Name:KWONG
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10175 FORTUNE PKWY
Mailing Address - Street 2:SUITE 1203
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3519
Mailing Address - Country:US
Mailing Address - Phone:904-519-5292
Mailing Address - Fax:904-519-5296
Practice Address - Street 1:10175 FORTUNE PKWY UNIT 1203
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6758
Practice Address - Country:US
Practice Address - Phone:904-519-5292
Practice Address - Fax:904-519-5296
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82288207N00000X
FLME 82288207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology