Provider Demographics
NPI:1912220989
Name:KWONG, KIN WING (RPH)
Entity Type:Individual
Prefix:
First Name:KIN WING
Middle Name:
Last Name:KWONG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 61ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-4211
Mailing Address - Country:US
Mailing Address - Phone:718-492-8889
Mailing Address - Fax:718-492-3883
Practice Address - Street 1:761 61ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4211
Practice Address - Country:US
Practice Address - Phone:718-492-8889
Practice Address - Fax:718-492-3883
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist