Provider Demographics
NPI:1891806154
Name:KWONG, MICHAEL YIU (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:YIU
Last Name:KWONG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 PRINCE ST STE 3D
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4650
Mailing Address - Country:US
Mailing Address - Phone:718-539-9001
Mailing Address - Fax:718-539-9173
Practice Address - Street 1:3712 PRINCE ST STE 3D
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4650
Practice Address - Country:US
Practice Address - Phone:718-539-9001
Practice Address - Fax:718-539-9173
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005316213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01912849Medicaid
NY03245Medicare ID - Type UnspecifiedMEDICARE
NYPA6752Medicare ID - Type UnspecifiedMEDICARE
NY01912849Medicaid