Provider Demographics
NPI:1881717197
Name:KWOK, MICHAEL LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LAWRENCE
Last Name:KWOK
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 1:1640 STAATS PL
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-1752
Mailing Address - Country:US
Mailing Address - Phone:626-799-5638
Mailing Address - Fax:
Practice Address - Street 1:3220 S BREA CANYON RD
Practice Address - Street 2:SUITE H
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3481
Practice Address - Country:US
Practice Address - Phone:909-594-1848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA054075207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine