Provider Demographics
NPI:1679605182
Name:KWONG, CHESTER (SW)
Entity Type:Individual
Prefix:MR
First Name:CHESTER
Middle Name:
Last Name:KWONG
Suffix:
Gender:M
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S MALLERY ST
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-5515
Mailing Address - Country:US
Mailing Address - Phone:505-544-2888
Mailing Address - Fax:
Practice Address - Street 1:1400 S IRON ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-5049
Practice Address - Country:US
Practice Address - Phone:505-546-4863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMB34561041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool