Provider Demographics
NPI:1750450276
Name:KWONG, LOUIS MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:MATTHEW
Last Name:KWONG
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 1:1000 W CARSON ST # 422
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2059
Mailing Address - Country:US
Mailing Address - Phone:424-306-7874
Mailing Address - Fax:310-533-2211
Practice Address - Street 1:1000 W CARSON ST RM 4L1
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:424-306-7874
Practice Address - Fax:310-533-2211
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55440207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG55440OtherMEDICARE PTAN
CAG55440OtherMEDICARE PTAN
CA1079790001Medicare NSC