Provider Demographics
NPI:1760419386
Name:KWONG, DONNA (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:KWONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27212 CALAROGA AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-4339
Mailing Address - Country:US
Mailing Address - Phone:510-785-5000
Mailing Address - Fax:510-784-2502
Practice Address - Street 1:4725 FIRST ST
Practice Address - Street 2:STE 100
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566
Practice Address - Country:US
Practice Address - Phone:925-462-7060
Practice Address - Fax:925-462-9712
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72182207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG22517Medicare UPIN