Provider Demographics
NPI:1114669546
Name:KWOK, ELLIUS JUN JIE (MD)
Entity Type:Individual
Prefix:
First Name:ELLIUS
Middle Name:JUN JIE
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 1:1015 WALNUT ST STE 620
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4306
Mailing Address - Country:US
Mailing Address - Phone:215-955-6864
Mailing Address - Fax:215-955-2878
Practice Address - Street 1:1015 WALNUT ST STE 620
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5005
Practice Address - Country:US
Practice Address - Phone:215-955-6864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMT227066208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program