Provider Demographics
NPI:1699971283
Name:KWOK, GARRICK KALUEN (MD)
Entity type:Individual
Prefix:DR
First Name:GARRICK
Middle Name:KALUEN
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 1:3400 MCCLURE BRIDGE ROAD
Mailing Address - Street 2:BUILDING A, SUITE B
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096
Mailing Address - Country:US
Mailing Address - Phone:678-404-1140
Mailing Address - Fax:
Practice Address - Street 1:3400 MCCLURE BRIDGE ROAD
Practice Address - Street 2:BUILDING A, SUITE B
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:678-404-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA70162208100000X, 2081P2900X
FLME 116649208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHN738ZMedicare PIN
FLHN738YMedicare PIN