Provider Demographics
NPI:1497749394
Name:KWOK, VANESSA BRENNAN (DO)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:BRENNAN
Last Name:KWOK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3401 CENTRE LAKE DR
Mailing Address - Street 2:SUITE 650
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-1201
Mailing Address - Country:US
Mailing Address - Phone:909-351-8529
Mailing Address - Fax:
Practice Address - Street 1:3401 CENTRE LAKE DR
Practice Address - Street 2:SUITE 650
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-1201
Practice Address - Country:US
Practice Address - Phone:909-351-8529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3972207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ817835-03Medicaid
AZH78013Medicare UPIN
AZZ84960Medicare PIN