Basic Information
| Provider Information | |||||||||
| NPI: | 1134364532 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KWANKAM | ||||||||
| FirstName: | MAUREEN MARY | ||||||||
| MiddleName: | YUNKAP | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 SELWYN AVE APT 17E | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104577666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814209716 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1265 FULTON AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104563401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189018294 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2008 | ||||||||
| LastUpdateDate: | 12/09/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 60263745 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.