Provider Demographics
NPI:1215036744
Name:KIOK, FERNANDO CHUA (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:CHUA
Last Name:KIOK
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 1:703 WINDERMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2645
Mailing Address - Country:US
Mailing Address - Phone:318-561-9907
Mailing Address - Fax:
Practice Address - Street 1:2495 SHREVEPORT HIGHWAY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71306
Practice Address - Country:US
Practice Address - Phone:318-473-0010
Practice Address - Fax:318-483-5117
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040095208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery