Provider Demographics
NPI:1194950402
Name:KWONG, RAYMOND P (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:P
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 1:7111 HARWIN DR STE 210
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2141
Mailing Address - Country:US
Mailing Address - Phone:713-339-1471
Mailing Address - Fax:713-339-1514
Practice Address - Street 1:7111 HARWIN DR STE 210
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2141
Practice Address - Country:US
Practice Address - Phone:713-339-1471
Practice Address - Fax:713-339-1514
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-16
Last Update Date:2009-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8227305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
C18087Medicare UPIN