Provider Demographics
NPI:1184820201
Name:KWONG, KELVIN MING-TAK (MD)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:MING-TAK
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 1:10 PLUM ST FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2066
Mailing Address - Country:US
Mailing Address - Phone:732-235-5530
Mailing Address - Fax:732-235-7220
Practice Address - Street 1:10 PLUM ST
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2065
Practice Address - Country:US
Practice Address - Phone:732-235-5530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09318800207Y00000X, 207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology