Provider Demographics
NPI:1659458826
Name:KWO-ON-YUEN, POW
Entity Type:Individual
Prefix:DR
First Name:POW
Middle Name:
Last Name:KWO-ON-YUEN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:REGIS
Other - Middle Name:
Other - Last Name:KWO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3031 TELEGRAPH AVE
Mailing Address - Street 2:217
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2051
Mailing Address - Country:US
Mailing Address - Phone:510-704-8364
Mailing Address - Fax:
Practice Address - Street 1:3031 TELEGRAPH AVE
Practice Address - Street 2:217
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2051
Practice Address - Country:US
Practice Address - Phone:510-704-8364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA457312084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE24828Medicare UPIN
CA00A457311Medicare ID - Type Unspecified