Provider Demographics
NPI:1609119767
Name:KWONG, CHRISTINA (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:KWONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S CHIPETA WAY # MS 115
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1221
Mailing Address - Country:US
Mailing Address - Phone:801-583-2787
Mailing Address - Fax:801-584-5207
Practice Address - Street 1:13103 E MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1642
Practice Address - Country:US
Practice Address - Phone:509-892-2700
Practice Address - Fax:509-892-2740
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.140957207ZP0102X
UT10330389-1205207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology