Provider Demographics
NPI:1225120769
Name:KWOCK, DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:KWOCK
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 1:1319 PUNAHOU STREET
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826
Mailing Address - Country:US
Mailing Address - Phone:808-941-7744
Mailing Address - Fax:808-941-7746
Practice Address - Street 1:1319 PUNAHOU STREET
Practice Address - Street 2:SUITE 1020
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826
Practice Address - Country:US
Practice Address - Phone:808-941-7744
Practice Address - Fax:808-941-7746
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-11054208000000X, 2080P0208X
CAG84261208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI53722701Medicaid
HI22935-1OtherHMSA
HI22935-1OtherQUEST
HI22935-1OtherHMSA