Provider Demographics
NPI:1316901705
Name:KWONG, CHRISTOPHER N (PA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:N
Last Name:KWONG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27650 FERRY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3845
Mailing Address - Country:US
Mailing Address - Phone:630-225-2663
Mailing Address - Fax:630-225-2399
Practice Address - Street 1:27650 FERRY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3845
Practice Address - Country:US
Practice Address - Phone:630-225-2663
Practice Address - Fax:630-225-2399
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-001674363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01130124OtherRR MEDICARE
ILP34630Medicare UPIN
IL206147146Medicare PIN